Feedback - Life Care International Hospital

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Email

info@lifecareinternationalhospital.com.pk

UAN Number

051-111-111-161

LIFE CARE INTERNATIONAL HOSPITAL

PATIENT FEEDBACK FORM

Patient Name *

Room / Ward

MR No *

Date

Department Visited OPD IPD Emergency (ER) Diagnostic Services

Consultant / Doctor Name

Service Area Evaluation Matrix

Rating Scale: 1 = Poor | 2 = Fair | 3 = Good | 4 = Very Good | 5 = Excellent

Service Area Component	1	2	3	4	5
Registration / Admission Process
Waiting Time for Consultation / Treatment
Courtesy of Front Desk Staff
Nursing Care (if applicable)
Cleanliness of Hospital
Cleanliness of Washrooms
Billing & Payment Process
Overall Quality of Care

General Verification

1. Were hospital staff respectful and courteous? Yes No

2. Did the doctor explain your condition clearly? Yes No

3. Did you receive timely care and attention? Yes No

4. Were the hospital facilities comfortable? Yes No

5. Would you recommend Life Care International Hospital to your family and friends? Definitely Yes
Probably Yes
Not Sure
No

Overall Satisfaction Engine Rating Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied

Any complaint or concern?

How likely are you to recommend Life Care International Hospital to others? (0-10)

0 1 2 3 4 5 6 7 8 9 10

Contact Number * (Format: 11 Digits)

Email Address * (Must include @)

Email

UAN Number

LIFE CARE INTERNATIONAL HOSPITAL

PATIENT FEEDBACK FORM

Service Area Evaluation Matrix

General Verification

Company

Our Services

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