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Hospital Visit Feedback

a) Is this your first visit to our hospital?

 Yes No

b) How would you rate the ambience of the department?

 Excellent Good Average

How would you rate the care provided by/ in the following areas of the department

a) Reception and Registration

 Excellent Good Average

b) Doctors Consultation

 Excellent Good Average

c) Hospital Facilities and Equipment

 Excellent Good Average

d) Quality of Food

 Excellent Good Average

e) Cleanliness of the Hospital facilities

 Excellent Good Average

f) Billing & Discharge

 Excellent Good Average

i)Insurance

 Excellent Good Average

j) Security System

 Excellent Good Average

k) Diagnostic (Blood sampling, Radiology, PFT, Cardiology)

 Excellent Good Average

What was the average time taken for the following services?

a) Registration and billing

 Less than 30 minutes 1-2 Hours More than 2 hours

b)Investigations

 2-4 hours 4-6 hours More than 6 hours

c)Doctors Consultation

 2-4 hours 4-6 hours More than 6 hours

d)Reports

 2-4 hours 4-6 hours More than 6 hours

e)Discharge Formalities

 2-4 hours 4-6 hours More than 6 hours

How would you rate the skills and knowledge of the following staff?

a)Nursing Staff

 Excellent Good Average

b)Medical Staff

 Excellent Good Average

How would you rate the Care and Concern provided by the following staff?

a)Nursing Staff

 Excellent Good Average

b)Medical Staff

 Excellent Good Average

a) On a scale of 1-5, with 1 being the lowest and 5 the highest, how would you rate the overall satisfaction with KG Hospital?

 1 2 3 4 5

b) Would you recommend this hospital to your friends and family?

 Yes No

Any member of the staff whose care and concern has impressed you a lot:

Suggestions for our hospital (if any)