ER Feedback

Excellent Good Average Poor

Admission done
1
Reception staff answered queries to
satisfaction
2 Financial Counseling

3 Doctors explained patient condition

4 Bed allotted within

<10 min 11-20 min 21-30 min >60 min
Nurse accompanied while shifting to room
5 YES NO
( if applicable)

Sign of relative:
Relation with Patient:
Phone Number: