Patient Feedback

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Patient Feedback Form

Thank you for choosing our clinic for your medical needs. Please provide feedback on your visit so we can continue improving our services. We appreciate your time!

Name

Phone number

Gender

Date of birth

How likely are you to recommend us to your friends or family?

Please rate your satisfaction with the hospital and provided services:

The overall quality you received

Communication & clarity of information provided

Cleanliness & maintenance of hospital facilities

Information provided for diagnosis and treatment

Efficiency of admission & discharge process

Tell us how we can improve:

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Patient Feedback Form

Please rate your satisfaction with the hospital and provided services:

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