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Patient Feedback Form (RC-103/104)
We would love to hear your thoughts or feedback on how we can improve your experience!
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Name
*
Your answer
email id
Your answer
mobile number
Your answer
Branch Visited
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Indore Race Course Road
Indore Satya Sai Square
Indore Sapna Sangeeta
Indore Kalani Nagar
Indore Pardesipura
Dewas
Shujalpur
Ujjain
Khandwa
Khargone
Dhar
Mhow
Vaibhav Nagar CC
Nipaniya CC
Visit id
Your answer
Sample taken from. (आपने सैंपल कहां दिया)
Home Visit (घर पर)
At Centre (सेंटर पर)
Clear selection
Pls rate your experience (कृपया अपना अनुभव शेयर करें) Staff Behaviour (स्टाफ का व्यवहार)
*
Good उत्तम
Satisfactory संतोषजनक
Average अमान्य
Pls rate your experience (कृपया अपना अनुभव शेयर करें) Quality of Reports (रिपोर्ट की गुणवत्ता)
*
Good उत्तम
Satisfactory संतोषजनक
Average अमान्य
Pls rate your experience (कृपया अपना अनुभव शेयर करें) Cleanliness and Facility (साफ सफाई एवम् व्यवस्था)
*
Good उत्तम
Satisfactory संतोषजनक
Average अमान्य
Your Suggestions (सुधार हेतु सुझाव)
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