web site statistics software

Online Feedback

You are our * :
How did you hear about us? * :
You were our patient as * :
Your treating physician :  
Name of the patient * :  
City :  
Country :  
Email ID * :  
Phone Number :  
Mobile Number :  
HH No * :  
Which is the most important criteria in deciding an hospital? * :  
Rate our specialists (attention to you, personalized care, promptness of treatment, quality of care) * :  
Rate our services (promptness of care, courtesy, pleasantness) * :  
How satisfied are you with the competency of our staff? * :  
Rate your overall experience * :  
We need to improve upon * :
We impressed you with * :
Our star performer (any employee you would like to mention for his/her exceptional attitude and performance) :
Any other comments :
Would you recommend us to others? * :  
How would you rate us compared to other health facilities you have visited? * :  
Type characters in the picture below
Letters are case-sensitive