Dear Customer,
Thank you for choosing Our services.Our commitment
is to offer services that meet the highest healthcare
standards.We hope that we have been able to measure
up to your expectations.

Please spare a few moments to fill in this form.Your
valuable feedback will enable us to serve you better.
Please share any comment's to improve us:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

How do you rate our staff and services? Please describe if any  members
Of our staff impressed you:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
                                  Rating's:                  Excellent Good Average Poor Services availed:
Consultation Diagnostics Pharmacy
Health Check-Up Physiotherapy
Any Other_______________________
Ability to handle all your queries: Email:
__________________________________________________
Courtesy and help offered:                     PID No:__________________ Age:________________
Speed of service delivery:                   Name:
__________________________________________________
Doctor's courtesy and interaction: Address:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Cleanliness within the clinic:                 
Phone Number:
_____________(Res.) _____________(Off.)
Layout and design of the clinic:             What additional service(s) would you like which are presently not available:
Dentistry Endoscopy Day Care Unit
Maternity Center IVF(Fertility Clinic)
MRI CT Scan
Any Other_____________________
Your overall experience over here: Would you come to this clinic
For your future health care need's: Yes       No
How did you know about the clinic:
AdvertisementPaper Insert's
TOI HT NBT

Banners               Road Shows(Specify Location)

________________        _________________
If no, comment on reason for dissatisfaction: __________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

__________________________
Signature & Date

thank you for your time.