Feed Back

We constantly want to improve our services for you, so please help us in getting the self assessment ,suggestion, comment, feedback by filling out this form.A part of this form may be used in Patient Testimonials section.

Name
Age
Mobile
Email
What were you treated for?
At which Hospital and when was the Surgery done?

Please rate us on a scale of 1 -5 for the following parameters (1 is extremely satisfied and 5 is extremely dissatisfied)

PRE OPERATIVE CONSULTATION
Thoroughness of Examination and time spent
Behavior of Doctor/ Staff
Waiting Time at clinic/ Appointment
Explanation of Problem & Surgery
Queries explained satisfactorily
Fees & Charges

Were you referred to any place for Hearing Tests/ Xray/ CTScan/ Blood Tests? Rate your overall experience on scale of 1to 5

SURGERY DAY EXPERIENCE
Behavior of Hospital Staff
Behavior of Doctors
Punctuality
Fees as per Estimate /Insurance payment

POSTOPERATIVE EXPERIENCE
Time taken for recovery as explained before
Thoroughness of Examination
Fees & charges
Explanation of Queries

Overall, how satisfied are you with the treatment? Please rate us on a scale of 1-5 (1 is extremely satisfied and 5 is extremely dissatisfied)

Would you recommend us to a friend? Why?

How did you come to know about us?( Yellow Pages/ Friends/ Internet)

Any Comments / Suggestions?

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