Name |
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Email |
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Age |
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Mobile |
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At which Hospital and when was the Surgery done? |
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Please rate us on a scale of 1 -5 for the following parameters
(5 is extremely satisfied and 1 is extremely dissatisfied) |
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PRE OPERATIVE CONSULTATION |
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Thoroughness of Examination and time spent |
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Behavior of Doctor/ Staff |
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Waiting Time at clinic/ Appointment |
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Explanation of Problem & Surgery |
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Queries explained satisfactorily |
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Fees & Charges |
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Were you referred to any place for Hearing Tests/ Xray/ CTScan/ Blood Tests? Rate your overall experience on scale of 1to 5
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SURGERY DAY EXPERIENCE
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Behavior of Hospital Staff |
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Behavior of Doctors |
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Punctuality |
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Fees as per Estimate /Insurance payment
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POSTOPERATIVE EXPERIENCE |
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Time taken for recovery as explained before
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Thoroughness of Examination |
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Fees & charges |
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Explanation of
Queries |
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Overall, how satisfied are you with the treatment? Please rate us on a
scale of 1-5 (5 is extremely satisfied and 1 is
extremely dissatisfied) |
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Would you recommend
us to a friend? Why? |
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How did you come to
know about us?( Yellow Pages/ Friends/ Internet) |
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Any Comments /
Suggestions? |
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