OPD Patient Feedback Form
Thank you for visiting EyeCare Hospital. Your feedback is invaluable to us in enhancing our services and patient care. We truly appreciate your time and input!
Patient Information
Name
Contact Number
Please rate your experience (Poor, Satisfactory, Good, Very Good, Excellent, Not Applicable)
1. Ease of Booking Appointment
Poor
Satisfactory
Good
Very Good
Excellent
2. Courtesy & Professionalism of the Booking Staff
Poor
Satisfactory
Good
Very Good
Excellent
3. Experience with Front Desk Staff
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
4. Experience with Clinical Assistant
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
5. Experience with Optometrist Consultation (Vision Check)
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
6. Experience with Ophthalmologist Consultation (Doctor Consultation)
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
7. Experience with Diagnosis & Nursing Services
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
8. Experience with Counselling Services
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
9. Experience with Pharmacy Services
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
10. Waiting Time & Service Efficiency
Poor
Satisfactory
Good
Very Good
Excellent
11. Explanation of Diagnosis & Sample Collection
Poor
Satisfactory
Good
Very Good
Excellent
12. Cleanliness & Hygiene of the Hospital
Poor
Satisfactory
Good
Very Good
Excellent
13. Billing Ease & Transparency
Poor
Satisfactory
Good
Very Good
Excellent
14. Your overall experience at EyeCare Hospital
Poor
Satisfactory
Good
Very Good
Excellent
Recommendation
15. Based on your experience, how likely are you to recommend EyeCare Hospital to others (Such as friends, family, or others)
0
1
2
3
4
5
6
7
8
9
10
Suggestions
16. Please share any comments, suggestions, or areas of improvement:
Submit Survey