Feedback - Cancer Centre Welfare Home and Research Institute

Feedback

FEEDBACK FORM

I came as a (Please Tick)

Patient

Relative

Visitor

Name:		Reg. No.:	Age: Sex: M / F
Address:
Phone		Email:
Bed:		Ward:		Doctor:
Diagnosis:		Treatment:

	My hospital stay at CCWH & RI was because of the following factors: -		Pleasant		Satisfactory		Unpleasant
	The Hospital environment is		Good		Average		Poor.
	The Toilet(s) are		Good		Average		Poor.
	The Food / Diet is		Good		Average		Poor.
	The service of attending Doctors is		Good		Average		Poor.
	The service of attendant Nurses is		Good		Average		Poor.
	The Hospital Billing is		Good		Average		Poor.
	The Reception / Enquiry service is		Good		Average		Poor.
	The Admission Process is		Good		Average		Poor.
	The Discharge Process is		Good		Average		Poor.
	Overall I rate CCWH & RI as		Good		Average		Poor.
	Special Comments: