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Feedback Form for Out-patient Services
 

 

A. APPOINTMENT CALL CENTRE  
1
 Response in answering call
Immediate
Prompt
Average
Delayed
2 Courtesy of operator
Excellent
Good
Fair
Poor
3
 Communication : Usefulness of Information
Excellent
Good
Fair
Poor
B. REGISTRATION PRODESS
1
 Information and assistance
Excellent
Good
Fair
Poor
2
 Registration Process
Quick and simple (>10 min)
Average wait (10 to 15 min)
Long wait (16 to 29 min)
delayed (>29 min)
C. MEDICAL SECRETARY  
1
 Attitude
Pleasant
Friendly
Warm
Indifferent
2
 Information and assistance
Excellent
Good
Fair
Poor
D. PHYSICIANS' CARE  
1
 Friendliness and politeness
Pleasant
Friendly
Warm
Indifferent
2
 Information and explanation : About diseases, treatment & other concerns
Excellent
Good
Fair
Poor
3
 Addressing concerns
Excellent
Good
Fair
Poor
 E. BILLING AND CASH COUNTER  
1
 Attitude, Courtesy and helpfulness
Pleasant
Friendly
Warm
Indifferent
2
 Payment Process
Quick and simple (<10 min)
Average wait (10 to 15 min)
Long wait (16 to 29 min)
Delayed (>29 min)
 F. INVESTIGATION/SAMPLE COLLECTION  
1
 Information & explanation
Excellent
Good
Fair
Poor
2
 Investigation/sample collection procedure
Quick and simple
Average wait
Long wait
Delayed
3
 Report delivery
Excellent
Good
Fair
Poor
G. ENVIRONMENT  
1
 Cleanliness, hygiene and tidiness
Excellent
Good
Fair
Poor
2
 Facilities, decor: signages, directions
Excellent
Good
Fair
Poor
3
 Temperature comfort and sitting arrangement
Excellent
Good
Fair
Poor
4
 Cleanliness of washrooms
Excellent
Good
Fair
Poor
H. PHARMACY  
1
 Attiude : Courtesy and helpfulness
Pleasant
Friendly
Warm
Indifferent
2
 Communication by pharmacist
Excellent
Good
Fair
Poor
3
 Medicine delivery time
Quick and simple (<10min)
Average wait (10 to 20 min)
Long wait (21 to 35 min)
Delayed (> 35 min)
4
 Availability of medicines
Excellent
Good
Fair
Poor
 I. OVERALL EXPERIENCE  
1
 Overall experience of services
Excellent
Good
Fair
Poor
 J. RECOMMEND THIS HOSPITAL TO OTHERS
Yes
No
   
 
K. HOW HAVE YOU COME TO KNOW ABOUT APOLLO HOSPITALS DHAKA?
My friends/relatives
Learn from media
Internet
Referred by community physician
Other clinic/hospital
Others
 L. ANY COMMENTS/SUGGESTIONS THAT WILL HELP US TO IMPROVE THE CARE WE PROVIDE
 
PLEASE INCLUDE YOUR NAME AND CONTACT
Patient's/Attendant's Name
UHID:
Bed:
Patient's Age:
Patient's Sex:
Contact Number:
Email:

 
HOTLINE : 10678
Ambulance : 01714-090000
Duty Manager : 01713-064563
Appointment :  8845242
PABX :  8401661
FAX :  8401679
Master Health Check :  8401600
Chittagong info : 01713-064555
Sylhet info : 01713-047461
Bogra info : 01713-229988
Khulna info : 01713-489191
 
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