Feedback Form Siloam Group

Feedback Form Grand Indonesia's Partner Hospital

Your feedback matters for the better working experience.
Thank you for your trust in using the PT Grand Indonesia Partner Hospital Health Facilities. Please take your time to fill out the attached feedback form to evaluate the collaboration between PT Grand Indonesia and Siloam Hospitals.

Terima kasih atas kepercayaan Bapak / Ibu menggunakan Fasilitas Kesehatan Rumah Sakit Rekanan PT Grand Indonesia. Mohon kesediaan waktu Bapak / Ibu untuk mengisi feedback form terlampir guna evaluasi kerjasama antara PT Grand Indonesia dengan Rumah Sakit Siloam.
Employee Number / NIK Karyawan*
Name / Nama*
Department / Departemen*
Branch Siloam / Siloam Cabang*
Type of Service / Jenis Pelayanan *

1. In general, how satisfied are you with the hospital staff services in the admission section? (Secara garis besar, seberapa puaskah Bapak / Ibu dengan pelayanan petugas Rumah Sakit di bagian pendaftaran ?)*

	1	2	3

1 is Extremely Dissatisfied, 3 is Extremely Satisfied

2. How satisfied are you with the facilities and equipment infrastructure at the hospital? (Bagaimana penilaian Bapak / Ibu terhadap fasilitas dan infrastruktur peralatan di Rumah Sakit?)*

	1	2	3

1 is Extremely Dissatisfied, 3 is Extremely Satisfied

3. How satisfied are you with the hospital doctor's services? (Bagaimana penilaian Bapak / Ibu terhadap kepuasan dari pelayanan dokter di Rumah Sakit?)*

	1	2	3

1 is Extremely Dissatisfied, 3 is Extremely Satisfied

4. How satisfied are you with nurse services at the hospital? (Bagaimana penilaian Bapak / Ibu terhadap pelayanan perawat di Rumah Sakit ?)*

	1	2	3

1 is Extremely Dissatisfied, 3 is Extremely Satisfied

5. How satisfied are you with cleanliness and comfort in the hospital environment? (Bagaimana penilaian Bapak / Ibu terhadap kebersihan dan kenyamanan di lingkungan Rumah Sakit ?)*

	1	2	3

1 is Extremely Dissatisfied, 3 is Extremely Satisfied

6. Do you agree that the partnership with Siloam hospitals will be continued. (Apakah Bapak / Ibu setuju jika kerjasama dengan RS Siloam akan dilanjutkan).*
If you disagree, please provide your reasons. (Berikan alasan Bapak / Ibu apabila tidak setuju).*
7. If you have any other comment, please share with us. (Silahkan mengisi kolom di bawah ini jika Bapak / Ibu memiliki komentar lainnya).
Scale / Skala

1: Extremely Dissatisfied / Sangat Tidak Puas

2: Satisfied / Puas

3: Extremely Satisfied / Sangat Puas
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