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FeedBack From

Dear Sir/Madam

We hope you had a comfortable stay. We welcome your suggestion and feedback on the service you have received at thos Hospital. All Information given you will be kept strictly confidential and will be used for the improvement of the Hospital services only.

Name of the patient: Reg. No.: Bed. No.:
Tel No: Email: Date of Admission:
Admitted under case of Doctor: Date of Discharge:
Your Admision Was:
The Reception staff was:
Your Room Was:
Cleanliness was:
Furniture and Fitting were in:
Lines was:

Food Services

Quality was:
Quantity was:


Nursing Care was in general:
Nursing Attitude Behaviour:

WARD STAFF(Ayahs, Ward Boys, Sweepers)

Medical Services by Consultants:
Resident Doctors Attended:

Comments and suggestions for Improvement:

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