Hospital
Feedback Survey
by Ruchira Madushan
Feedback Form
Name:
Patient ID:
Interaction with Physician:
Excellent
Good
Average
Poor
Physician's Communication:
Excellent
Good
Average
Poor
Physician's Knowledge:
Excellent
Good
Average
Poor
Physician's Professionalism:
Excellent
Good
Average
Poor
Pharmacy Service:
Excellent
Good
Average
Poor
Medication Availability:
Excellent
Good
Average
Poor
Pharmacy Staff Behavior:
Excellent
Good
Average
Poor
Wait Time:
Excellent
Good
Average
Poor
Overall Experience:
Excellent
Good
Average
Poor
Additional Comments:
Submit Feedback
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