MULTILINGUAL - CUSTOMER SURVEY FEEDBACK FORM
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  • CUSTOMER SURVEY FEEDBACK FORM

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  • Good day, please select the service that you would like to rate*
  • Please select the clinic that you would like to rate*
  • Please select the ward that you would like to rate*
  • Which F&B section would you like to rate*
  • Which Physiotherapy unit would you like to rate*
  • Which Housekeeping section would you like to rate*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Did the staff check on your name and date of birth?*
  • Were you given a proper follow-up instructions if your condition/sickness worsened?*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Did the staff check on your name and date of birth?*
  • Did the nurse ask whether you have any allergies before serving medication?*
  • Did the nurse check on your condition during ward rounds?*
  • Were you given a proper follow-up instructions if your condition/sickness worsened?*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Did the staff check on your name and date of birth?*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • Which aspect(s) do you rate as above? You may select 1 or more options.*
  • How did you book your appointment?*
  • Did you receive reminder for each of your appointment?*
  • Were you updated when delay are anticipated?*
  • Considering your complete experience with our hospital, would you recommend us to your family, friend or colleague?*
  • Should be Empty: