Patient Feedback Form We value your feedback and are committed to continuously improving your experience at Well-Life Hospital. WELL-LIFE HOSPITAL Patient & Visitor Experience Feedback Form Your feedback helps us improve our services. This survey takes less than 5 minutes to complete. WELL-LIFE HOSPITAL Patient & Visitor Experience Feedback FormΔSECTION A: VISIT INFORMATION(Helps us understand your experience better)What type of visit was this? Outpatient Inpatient Emergency Non-medical visitIs this your first visit? Yes NoWhich areas did you interact with today? (Select all that apply) Security / Gate Reception Nurses Doctor Laboratory Pharmacy Inpatient WardSECTION B: SECURITY / GATE EXPERIENCE Please rate the following:Courtesy and professionalism of the security staff Very Poor Poor Fair Good ExcellentEase of entry and directions given Very Poor Poor Fair Good ExcellentOverall first impression of the hospital environment Very Poor Poor Fair Good ExcellentSECTION C: RECEPTION & WAITING AREA EXPERIENCEPlease rate the following:Friendliness and helpfulness of the reception staff Very Poor Poor Fair Good ExcellentHow long did you wait before being attended to at reception? Less than 10 Minutes 10 - 20 Minutes 20 - 30 Minutes More than 30 MinutesComfort and cleanliness of the waiting area Very Poor Poor Fair Good ExcellentClarity of information provided at reception Very Poor Poor Fair Good ExcellentSECTION D: NURSING CARE (If Applicable)Please rate the following:Courtesy and empathy of the nursing staff Very Poor Poor Fair Good ExcellentResponsiveness to your needs Very Poor Poor Fair Good ExcellentCommunication and explanations given Very Poor Poor Fair Good ExcellentSECTION E: MEDICAL OFFICERS (DOCTORS) (If Applicable)Please rate the following:Professionalism of the doctor Very Poor Poor Fair Good ExcellentClarity of diagnosis and explanation of treatment Very Poor Poor Fair Good ExcellentTime spent addressing your concerns Very Poor Poor Fair Good ExcellentOverall confidence in the care you received Very Poor Poor Fair Good ExcellentOverall confidence in the care you received Very Poor Poor Fair Good ExcellentSECTION F: LABORATORY SERVICES (If Applicable)Please rate the following:Waiting time for laboratory tests Very Poor Poor Fair Good ExcellentProfessionalism of laboratory staff Very Poor Poor Fair Good ExcellentClarity of instructions given Very Poor Poor Fair Good ExcellentSECTION G: PHARMACY SERVICES (If Applicable)Please rate the following:Waiting time at the pharmacy Very Poor Poor Fair Good ExcellentAvailability of prescribed medications Very Poor Poor Fair Good ExcellentExplanation of medications by pharmacy staff Very Poor Poor Fair Good ExcellentAttitude and professionalism of pharmacy staff Very Poor Poor Fair Good ExcellentSECTION H: INPATIENT CARE (If Applicable)Please rate the following:Attentiveness of inpatient attendants Very Poor Poor Fair Good ExcellentCleanliness and comfort of the ward Very Poor Poor Fair Good ExcellentOverall support during your stay Very Poor Poor Fair Good ExcellentSECTION I: OVERALL EXPERIENCEPlease rate the following:Overall, how satisfied were you with your visit? Very Dissatisfied Dissatisfied Neutral Satisfied Very SatisfiedHow likely are you to recommend Well-Life Hospital to family or friends? (Scale of 1 - 10) 1 2 3 4 5 6 7 8 9 10Did you experience any major delays or challenges during your visit? Yes NoSECTION J: OPEN FEEDBACKPlease rate the following:What did we do well during your visit?What can we improve to serve you better?SECTION K: FOLLOW-UP (Optional)Your responses are completely anonymous.Sharing your contact details is optional and only needed if you would like us to follow up on your feedback.Would you like us to contact you regarding your feedback? Yes NoPreferred contact Channel (optional): Email WhatsApp Phone CallEmailWhatsApp NumberMobile NumberSubmit Form
