Inpatient Feedback – PSG Hospitals

In Patient Feedback Form

Dear Patient / Relative / Visitor,

Your Continuing support & suggestions helps our hospital a better organisation. Kindly spare a few moments to complete the following. So that we can strive to fulfill your expectations.

Patient Name
IP Number
Date of Consultation
Dept./Unit
Doctor Name
Phone No.
- Patient
- Relative
- Visitor
Reason for choosing PSG Hospitals
- Referred by a Doctor
- Reputation of the Hospital's
- Recommended by others
- Reputation of the Doctor
- Previous experience in PSGH
Any other Reason?(Please Specify)
- Good
- Satisfactory
- Poor

	Excellent	Satisfactory	Good	Poor	NA
Admission System
Signage boards & Display
Doctors communication
Nurses communication
Billing services
Radiology Services (X-Ray,CT,MRI,Ultrasound,Mammogram)
Pharmacy Services
Discharge Process
Security Services
Dietary services
Quality of Food
Drinking Water facility
Canteen Facility
Facilities in room / ward
Cleanliness of room / ward & toilets
Wheel chair / Trolley facility
Respecting Patient Rights

Others if any
Please notify your suggestions for further improvement of our services
Would you like to appreciate any staff for their outstanding care and services?
Name & Department
- Yes
- No

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