INPATIENT FEEDBACK FORM

                   MAHATMA GANDHI MEDICAL COLLEGE & RESEARCH INSTITUTE HOSPITAL
                                                 Pillaiyarkuppam ,Pondicherry 607402
                           Email id : customercare@mgmcri.ac.in , Mobile No:9442203266
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Patient Name: *
IP NO/MR.No: *
MOBILE NUMBER :  *
EMAIL ID:
DATE OF ADMISSION :
MM
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DD
/
YYYY
DATE OF DISCHARGE :
MM
/
DD
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YYYY
HELP DESK /ADMISSION/REGISTRATION STAFF:
1. Attending Queries
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2. Time Taken
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3. Emergency Staff Service
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RADIOLOGY SERVICES:
1.Wating time and its timely Updates
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2.Timeliness of Report
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LABORATORY SERVICES:
1.Explaining Queries
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2.Timeliness of Report
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HOUSEKEEPING SERVICES :
1.Ward/Room Cleanliness
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2.Attitude & Behavior
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BLOOD BANK :
1.Explaining Queries
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NURSING CARE SERVICES :
1.Promptness in Services
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2.Knowledge in Skills
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3.Patient Education
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DOCTOR CONSULATION :
1.Explanation of Medication and Treatment Process
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2.Daily Visits
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3.Response to Queries
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4.Patient Education
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PHARMACY :
1.Avalability of Prescribed Medication
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2.Waiting Time
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BILLING :
1.Bill Queries Explanations
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2.Response and Courtesy of Billing Staff
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3.Time taken for bill clearance
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DISCHARGE PROCESS :
1.Time Taken for Discharge Process
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2.Explanation of Discharge Summary
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3.Exit formalities
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FACILITIES :
1.Care,Concern & Courtesy of Employees
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2.In-house transport (wheel chair & stretcher)
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3.Security assistance
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4.Dietary Services
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5.Hospital Linen
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6.Signage (Direction and Information)
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HOW LIKELY ARE YOU TO RECOMMEND US TO A FRIEND OR FAMILY MEMBER ?
Please mention your expectations and suggestions for our better improvement :
Positive or Negative Comments :
Best Performance :
* Confidentiality will be maintained for Name/Personal details entered here along with this feedback, Feedback provided will be projected as testimonial in the public , digital platforms or scientific publications. 
Thank you for your valuable feedback. We assure to put in our efforts to consider your suggestions.
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This form was created inside of Mahatma Gandhi Medical College Research Institute.