OPD Patient Feedback
Your feedback helps us improve our services and provide the best possible care. This form will take only 2–3 minutes to complete.
Patient Information
Patient Name
UHID / Patient ID
Mobile Number
Gender
Please Select
Male
Female
Other
Address
Consulting Doctor Name
Your Visit Type
First Visit
Follow-up Visit
Appointment & Registration Informations
1. How would you rate the behavior of our reception staff guided properly?
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Waiting Time
2. How satisfied were you with the waiting time?
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
3. Approximately how long did you wait?
Less than 10 minutes
10–20 minutes
20–30 minutes
More than 1 hour
4. Were you informed about any delay?
Yes
No
Not Applicable
Doctor Consultation
5. Did the doctor listen to your concerns carefully and explained clearly?
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Hospital Environment
6. Cleanliness and hygiene of the hospital
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Billing Experience (If Applicable)
7. Billing process was easy and transparent
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
8. Billing staff behavior
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Pharmacy (If Applicable)
9. Availability of prescribed medicines
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
10. Pharmacy staff behavior
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Laboratory / Radiology (If Applicable)
11. Staff Behavior
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
12. Waiting time
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
Overall Experience
13. Overall satisfaction with your visit
*
Bad
1
2
3
4
5
6
7
8
9
V-Very Good
10
1 is Bad , 10 is V-Very Good
14. Did your experience meet your expectations?
Exceeded Expectations
Met Expectations
Below Expectations
15. Any final comments?
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