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Name:
E-mail:
Home Address::
Mobile Phone::
Sex: Male  Female
Caring attitude of our doctors: Poor  Satisfactory  Good  Excellent
Performance of our housekeepers/cleaners: Poor  Satisfactory  Good  Excellent
Neatness of our hospital enviroment: Poor  Satisfactory  Good  Excellent
Infrastructure: A/C, generator, TV, computers etc: Poor  Satisfactory  Good  Excellent
Neatness of our gents/ladies: Poor  Satisfactory  Good  Excellent
Communication/Listening Skills: Poor  Satisfactory  Good  Excellent
Services: Poor  Satisfactory  Good  Excellent
What is the quality of our service?: Poor  Satisfactory  Good  Excellent
Caring attitude of the nurses: Poor  Satisfactory  Good  Excellent
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