E-Survey

Inpatient Satisfaction Survey

Our Medicine Services

Our nurse

Our Diagnostic Services

Laboratory services	Very good Good Enough Bad
Medical imaging and radiology services	Very good Good Enough Bad

General Status of Our Hospital

Inpatient Satisfaction Survey

Unit you receive service from
Are you coming to our hospital for the first time?	Yes No
Did your appointment take place on time?	Yes No
Appointment waiting time
Call center and communication services	Very good Good Enough Bad

General Evaluation

Your overall satisfaction	Very good Good Enough Bad
Would you recommend our hospital to others?	Yes No
Other comments and suggestions you want to convey in order to provide you with a better service

Your Personal Information

Questioner	Patient Patient Relative
Department you receive service from
Name Surname
Date of birth
Sexuality	Male Female
Physician
E-Mail
Cell Phone

Security Code

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