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Please rate your satisfaction with your outpatient experience

How likely are you to recommend our clinic/hospital to your family or friends?

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0 Not at all likely	1	2	3	4	5	6	7	8	9	10 Extremely likely
Extremely likely

Please rate the following aspects of your outpatient experience

	Very Poor	Poor	Average	Good	Excellent
Waiting Time	Very Poor	Poor	Average	Good	Excellent
Staff Friendliness	Very Poor	Poor	Average	Good	Excellent
Cleanliness and Hygiene	Very Poor	Poor	Average	Good	Excellent
Clarity of Instructions	Very Poor	Poor	Average	Good	Excellent
Quality of Care	Very Poor	Poor	Average	Good	Excellent

How would you rate the experience with the doctor who attended to you?

Was the appointment booking process convenient and efficient?

How would you rate the ease of finding information about our clinic/hospital (e.g., location, services)?

Did you receive timely reminders or notifications regarding your appointment?

Were the facilities and amenities at the clinic/hospital adequate and comfortable?

Did the healthcare provider explain your diagnosis and treatment plan clearly?

Were all your questions and concerns addressed during your visit?

Please provide any additional comments or suggestions for improvement

Would you like to be contacted for further feedback or follow-up?

Personal Information

Full Name

Contact Number

Email Address

Patient ID

Thank you for your feedback!