1. Please specify your gender. Male Female
2. Which age group do you fall into? Below 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 70 to 80 and above
3. How many times have you availed the healthcare facilities offered by our hospital in the past?
4. In which department were you seen by a health care provider in your recent visit to the hospital? Family Practice Gynaecology Internal Medicine Pediatrics Rheumatology Skincare Surgery Any other, please specify
5. How much time do you have to usually wait before you can see the healthcare provider?
6. Are you able to schedule your appointment in a reasonable amount of time? Yes No Other
7. What would you say about the person handling the phone queries? Very prompt Slow Gave the advice needed Well informed Courteous Helpful Rude Not well informed Other
8. How did you find our healthcare provider(s) in the following areas?
9. What do think regarding the hospital's facilities in the following areas?
10. What will be the reason for you to refer a friend or family members to our hospital?
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