Theatre Feedback Form
We would love to hear your thoughts, suggestions, concerns or problems with anything so we can improve!
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Hospital Card Number
EYE FOUNDATION HOSPITAL LOCATION
Please Select
Eye Foundation Hospital Ikeja
Eye Foundation Hospital Lekki (providence street)
Eye Foundation Hospital (Lekki Admiralty way)
Eye Foundation Hospital Ikorodu
Eye Foundation Hospital Ijebu Imushin
Eye Foundation Hospital Abeokuta
Eye Foundation Hospital Abuja (APO legislative quarters
Eye Foundation Hospital Ikeja Abuja (Gwarinpa)
Please kindly select the hospital branch you visited
Surgery Date
-
Day
-
Month
Year
Date
On a scale of 1-5 how would you rate the admission process?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5 how would you rate the degree of tidiness of our rooms?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5 how would rate the state of our room facilities?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5 how satisfied are you with the care you received?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5 how would you rate your overall experience with the Eye Foundation Hospital?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Was the information provided by our nurses and doctors prior to the surgery/Admission easily understood?
YES
NO
Did you feel your privacy, dignity and personal needswere met?
YES
NO
Did you feel your privacy, dignity and personal needs were met?
YES
NO
Would you recommend Eye Foundation Hospital?
YES
NO
If No (we do sincerely apologize) please explain why?
Please Comment on How We can Improve Our Services Here in Eye Foundation Hospital?
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