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Patient Feedback / Suggestions Form

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Patient Feedback/Suggestions Form

Epic Hospital is thankful to you for giving us the opportunity to serve you. To help us in our journey to serve you better we sincerely request you to kindly give us your opinion and suggestions on the treatment provided and services offered at different level by checking the appropriate box. Your identity will remain confidential at all times. We appreciate your feedback and assure you of our best services always.

FULL NAME


CONTACT NUMBER


EMAIL ID



PROMPTNESS AND COURTEOUS BEHAVIOR OF THE BILLING / RECEPTION COUNTER
ExcellentGoodAverageBelow AverageUnacceptable


PLEASE RATE YOUR EXPERIENCE WITH THE CONSULTANT/DOCTOR
ExcellentGoodAverageBelow AverageUnacceptable


COURTESY OF THE DOCTOR AND THE NURSING STAFF.
ExcellentGoodAverageBelow AverageUnacceptable


TIMELY AVAILABILITY OF THE INVESTIGATION REPORT
ExcellentGoodAverageBelow AverageUnacceptable


CLEANLINESS OF THE TOILETS
ExcellentGoodAverageBelow AverageUnacceptable


CAFETERIA/F&B SERVICES AT THE HOSPITAL
ExcellentGoodAverageBelow AverageUnacceptable


WOULD YOU CONSIDER EPIC HOSPITAL FOR FUTURE MEDICAL NEEDS?
ExcellentGoodAverageBelow AverageUnacceptable


WOULD YOU LIKE TO GIVE US ANY MESSAGE?

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