Patient Feedback - Inpatient Services
 
Name Age
Sex Male Female Category of Patient
Unit/Department Ward
Name of the Doctor(Optional)      
 
Why did you choose to come to CMC Hospital for treatment
  Recommended by others
Previous experience in CMC
Referred by a Doctor
Good Reputation
Any other reason? (Please specify)
 
Date of Admission Date of Discharge
Phone Number Email ID
 
Please rate the following staff in the Inpatient Department of CMC
Excellent
Good
Satisfactory
Poor
V.Poor
Billing counter staff
Doctors
Nurses
Attenders
Sweepers
Blood Collection technicians
Dietiticians
Dietary Servers
Security Staff
 
Please rate the following services
 
Excellent
Good
Satisfactory
Poor
V.Poor
Admission System
Medical Services by the Doctors
Nursing Services
X- Ray services
Blood Collection Area
Pharmacy services
Dietary Services
Billing Services
Security Department
 
Please rate the following facilities
Excellent
Good
Satisfactory
Poor
V.Poor
Drinking Water
Toilets
Hospital Linen
Signboards and signposts
Cafeteria
 
Based on your current experience, would you recommend this hospital to your Family/Friends?
Strongly recommend   Likely to recommend   Unlikely to recommend   Will not recommend   Neutral
 
Do you wish to Compliment any staff for outstanding care and services?
 
Please share your experience at the hospital with us and any Suggestions on how we can further improve our services.