Scribd Logo
Upload

Welcome to Scribd!

  • Patient - Driver Feedback Form-Bridgestone Sarathi Support Centre, Nigadi

    Uploaded by

    Ashok Dadas
    4 views4 pages
    The document appears to be a patient feedback form for a support center, asking for feedback on doctors, nurses, waiting times, hygiene, medicine quality, and suggestions through questions about gender, name, mobile number, and ratings and comments on various services. It requests the respondent's name, contact details, and opinions on staff knowledge and behavior, as well as facility cleanliness, wait times, and medication quality.

    Original Description:

    Original Title

    Patient_Driver Feedback Form-Bridgestone Sarathi Support Centre, Nigadi

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document appears to be a patient feedback form for a support center, asking for feedback on doctors, nurses, waiting times, hygiene, medicine quality, and suggestions through questions about gender, name, mobile number, and ratings and comments on various services. It requests the respondent's name, contact details, and opinions on staff knowledge and behavior, as well as facility cleanliness, wait times, and medication quality.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views4 pages

    Patient - Driver Feedback Form-Bridgestone Sarathi Support Centre, Nigadi

    Uploaded by

    Ashok Dadas
    The document appears to be a patient feedback form for a support center, asking for feedback on doctors, nurses, waiting times, hygiene, medicine quality, and suggestions through questions about gender, name, mobile number, and ratings and comments on various services. It requests the respondent's name, contact details, and opinions on staff knowledge and behavior, as well as facility cleanliness, wait times, and medication quality.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    Patient/Driver Feedback Form-

    Bridgestone Sarathi Support Centre,


    Nigadi
    ashok.ds@nirmanindia.org.in Switch account
    Not shared

    * Indicates required question

    Sex *

    Male

    Female

    Trangender

    Other:

    Name

    Your answer

    Mobile number

    Your answer
    *

    Excellent Good Average Poor Very Poor

    Doctor
    Knowledge
    General
    Practioner

    Doctor
    Kindness &
    Behaviour
    General
    Prationer

    Opthalmistic
    Doctor
    Knowledge

    Opthalmistic
    Doctor
    Kindness &
    Behaviour

    Nurse Patience

    Nurse
    Knowledge

    Waiting Time

    Hygiene

    Medicine
    Quality
    Quality
    Spectacles
    Quality
    Spectacles
    Quality

    Any other Suggestion to improve our services *

    Your answer

    Submit Clear form

    Never submit passwords through Google Forms.

    This form was created inside of Nirman Bahuuddeshiya Vikas Sanstha. Report Abuse

    Forms

    You might also like