The City Hospital :: Patient Satisfaction Survey

Feedback about your doctor.

Fields marked with * are mandatory.

Patient Information
Name *
Email *
Date of Birth*
TCHGEN No	[ Patient's Registration Number ]
Select Doctor
Doctor *
Rate your Experience
Scale: 5 - Exceptional; 4 - Exceeds Expectations; 3 - Meets Expectations; 2 - Below Expectations; 1 - Need Improvement
Were your appointments postponed or rescheduled more than once? 12345
Did your Doctor make you feel comfortable and at ease? 12345
How was your level of communication with your doctor? 12345
Did your Doctor fulfill your expectations when assessing your problems? 12345
Did your Doctor respond effectively to your issues / queries / complaints? 12345
Did you have enough time for consultation with your Doctor? 12345
Were you happy with the overall service provided by the Doctor? 12345
Comments *
Please help us to continuously improve our services. All comments, suggestions, recommendations are gratefully received.
Verification *	Please enter the text displayed.

Note: All information filled will be treated in confidence.