IP PSS

Patient Satisfaction Form - IP
At REEM Hospital YOUR VOICE Matters, We would love to hear your feedback regarding your Experience with us.

Kindly fill out the below Satisfaction Survey in order to help us improve our service.

Thank you for choosing REEM Hospital
Name*
Room No*
Date*

DayMonthYear
Date
Mobile Number*
Please enter a valid phone number.
Overall Experience with the Nurses during your stay

1 STAR = POOR EXPERIENCE 2 STARS = GOOD EXPERIENCE 3 STARS = EXCELLENT EXPERIENCE
Overall Experience with the Physicians during your stay

1 STAR = POOR EXPERIENCE 2 STARS = GOOD EXPERIENCE 3 STARS = EXCELLENT EXPERIENCE
Overall Experience with the Patient Experience Team during your stay

1 STAR = POOR EXPERIENCE 2 STARS = GOOD EXPERIENCE 3 STARS = EXCELLENT EXPERIENCE
Overall satisfaction with the room during your stay

1 STAR = NOT IMPRESSED 2 STARS = IMPRESSED 3 STARS = VERY IMPRESSED
Overall satisfaction with the quality of food during your stay

1 STAR = NOT IMPRESSED 2 STARS = IMPRESSED 3 STARS = VERY IMPRESSED
Overall rating of your experience during your stay

1 STAR = POOR EXPERIENCE 2 STARS = GOOD EXPERIENCE 3 STARS = EXCELLENT EXPERIENCE
Please provide your feedback related to the above rating
Upload supportive documents if needed.

Cancelof
Should be Empty:

Patient Satisfaction Form - IP