IPD Feedback Form

Dear Patient / Relative,

Thank you for having faith in us. Your continuing suggestions & support will help to make our Hospital a better organization. Kindly spare a few moments to complete the following, so that we can strive to fulfill your expectations.

Please Tell Us

Is this your first visit to Nazar Kanwar Surana Hospital? Yes No

Why did you choose Nazar Kanwar Surana Hospital? (Tick all that apply)

Doctor's & Clinical Expertise

Medical Services

Doctor's Recommendation

Friends/Relative's Recommendation

Insurance Panel

Reputation of Hospital

Due to Nearest Location

Others (Please specify)




Admission Services

Response of Reception/Enquiry Staff Poor Average Good Excelent

Promptness of addmision process Poor Average Good Excelent

Behaviour of reception staff Poor Average Good Excelent

Medical Services

Medical Care (by the Doctor) Poor Average Good Excelent

Nursing Services

Timely response to call Poor Average Good Excelent

Respect for privacy Poor Average Good Excelent

Care towards patient Poor Average Good Excelent

Behaviour of Nursing Staff Poor Average Good Excelent

Support Services

Pharmacy Services Poor Average Good Excelent

Security Services Poor Average Good Excelent

Cleanliness(Room, Toilet/ Bathroom) Poor Average Good Excelent

Behaviour of housekceping/cleaning staff/aayas Poor Average Good Excelent

Dietary Services & Dietician

Final counselling by Dietician Poor Average Good Excelent

Taste of food Poor Average Good Excelent

Hygiene precautions taken while serving food Poor Average Good Excelent

Behaviour of Dietician Poor Average Good Excelent

Discharge Process

Speed of Discharge process Poor Average Good Excelent

Billing process Poor Average Good Excelent

Overall impression of discharge process Poor Average Good Excelent

Would you like to recommend this hospital to any of your friend or family? Yes No




Your compliments and concerns are important for us.
Thank you for your feedback and helping us to serve you better

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