Aravind Eye Hospital Madurai Out Patient Feedback Form

Unit/ Clinic : Date :

Dear Sir/ Madam,
Aravind Eye Hospital is committed to giving high quality eye care in friendly manner in a clean environment. We strive for continual improvement. Your feedback helps us to attain higher standards and deliver better care to community.

SI.No   Highly Satisfied Satisfied Poor
1 Registration      
  Waiting time for registration      
  Attentiveness and politeness      
  Guiding you to Units/Clinics?      
2 Refraction      
  Waiting time for refraction      
  Satisfied with the test performed      
3 Nursing services      
  Attentiveness and courteousness      
  Guided and explained properly      
  Politeness of nurses      
4 Medical services      
  Waiting time for Consultation      
  Adequate explanation about disease and treatment      
  Time spent by the doctor      
  Service at Pharmacy      
5 Counselling      
  Waiting time for counselling      
  Guided and explained properly      
  Information given by counselors      
  Clears all doubts about the treatment      
6 Infrastructure      
  Cleanliness      
  Signages      
  Ambiance      
  Security      
  Coffee Shop      
  Lift      
7 Why do you choose our hospital
Quality of Service       Recommendation
Facilities available       Price/Expenditure
Doctors       Clinical expertise

THANK YOU FOR GIVING US YOUR VALUABLE TIME
(Note: You may handover the filled in questionnaire to the Unit co-ordinator)

Any comments :

Appreciation of staff :