Hindu Mission Health Services

Patient Name

:

Please enter the name

Sex

:

Male

FeMale

E-Mail Id

:

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Age	:	Please enter your age
Category	:

PLEASE LET US KNOW YOUR OPINION ON THE FOLLOWING :

1.

Level of Medical Services

:

By Doctors

:

Excellent

Good

Average

Can

By Nurses

:

Excellent

Good

Average

Can

By Other Staffs

:

Excellent

Good

Average

Can

2.

Did you find room clean and tidy?

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3.

Whether the lights and taps were working properly?

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4.

How did you find the atmosphere?

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5.

Do you have any suggestion for further improvement?

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