Shanti Memorial Hospital

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We are grateful to you for giving us the opportunity to serve you. To help us in our Endeavour to serve you better we sincerely request you to kindly give us your opinion and suggestions on the hospitals services by checking the appropriate box. Your identity will remain confidential at all times. We appreciate your feedback and assure you of our best services always.

Excellent= 5

Good= 4

Fair= 3

Poor= 2

Unacceptable= 1

* Required
The Ranking to be given as follows :

IPD

Q1) Availibility of sufficient information at the Registration / Admission counter
5 4 3 2 1

Q2) Waiting time at the Registration / Admission counter
5 4 3 2 1

Q3) Behavior and attitude of staff at the Registration / Admission counter
5 4 3 2 1

Q4) Your feedback on discharge process
5 4 3 2 1

Q5) Cleanliness of the wards
5 4 3 2 1

Q6) Cleanliness of Bathrooms and Toilets
5 4 3 2 1

Q7) Cleanliness of Bed sheets/ pillow covers etc.
5 4 3 2 1

Q8) Cleanliness of surroundings and campus drains
5 4 3 2 1

Q9) Regularity of Doctor’s attending you or your patient
5 4 3 2 1

Q10) Attitude and communication of Doctors
5 4 3 2 1

Q11) Time spent for examination of patient and counseling
5 4 3 2 1

Q12) Promptness in response by nurses in the wards
5 4 3 2 1

Q13) Round the clock availability of Nurses in the ward
5 4 3 2 1

Q14) Attitude and communication of Nurses
5 4 3 2 1

Q15) Availability , attitude & Promptness of house keeping staff
5 4 3 2 1

Q16) All prescribed drugs were they available at the hospital pharmacy
5 4 3 2 1

Q17) Were diagnostics services available within the hospital
5 4 3 2 1

Q18) Was your diet suppled in time
5 4 3 2 1

Q19) Your overall satisfaction during the treatment of your patient in the ward / cabin
5 4 3 2 1

Q20) Was the diet provided of good quality
5 4 3 2 1

Q21) Did the the Dietician explained your diet in advance
5 4 3 2 1

Q22) Cleanliness of the serving personnel
5 4 3 2 1

Q23) Your overall satisfaction during the treatment as In-patient
5 4 3 2 1

OPD

Q1) Availability of sufficient information at the waiting area
5 4 3 2 1

Q2) Wating time at the registration counter
5 4 3 2 1

Q3) Behaviour and attitude of hospital Front Office staff
5 4 3 2 1

Q4) Behaviour and attitude of hospital OPD Nurses
5 4 3 2 1

Q5) Promptness of nurses and Care provided to you by OPD nurses
5 4 3 2 1

Q6) Information provided to you by hospital staff about treatment & procedures
5 4 3 2 1

Q7) Cleanliness of the OPD and ambience
5 4 3 2 1

Q8) Cleanliness of the Bathrooms and toilets
5 4 3 2 1

Q9) Attitude and communication of doctors
5 4 3 2 1

Q10) Your waiting time for doctor`s consultation
5 4 3 2 1

Q11) Time spent for examination and counselling
5 4 3 2 1

Q12) Availabilty of lab and radiology test services
5 4 3 2 1

Q13) Promptness at pharmacy counter
5 4 3 2 1

Q14) Availability of drugs at the pharmacy
5 4 3 2 1

Q15) Your overall satisfaction of your visit to the hospital OPD
5 4 3 2 1

ICU

Q1) Provision of sufficient information by ICU staff
5 4 3 2 1

Q2) Patient was shifted to ICU in time
5 4 3 2 1

Q3) Behavior and attitude of ICU staff
5 4 3 2 1

Q4) Communication of Nurses to you regarding patient condition
5 4 3 2 1

Q5) Communication of ICU Coordinator to you regarding payment & Conselling
5 4 3 2 1

Q6) What you feel about the care provided to the patient
5 4 3 2 1

Q7) Time taken on discharge process
5 4 3 2 1

Q8) Cleanliness of Bed sheets/ pillow covers etc
5 4 3 2 1

Q9) Cleanliness of the ICU environment
5 4 3 2 1

Q10) ICU equipments used for patient found properly handled and run
5 4 3 2 1

Q11) Were your doctors attending your patients in time
5 4 3 2 1

Q12) Attitude and communication of Doctors
5 4 3 2 1

Q13) All prescribed drugs were available from the Hospital
5 4 3 2 1

Q14) Diagnostics services were provided within the hospital
5 4 3 2 1

Q15) Diagnostic service results were available within desired time
5 4 3 2 1

Q16) How was the treatment to your patient provided in the ICU
5 4 3 2 1

Q17) Your overall satisfaction during the treatment of your patient
5 4 3 2 1

CANTEEN

Q1) Availability of information at the Counter on the varieties of food available
5 4 3 2 1

Q2) Waiting time for food to be served
5 4 3 2 1

Q3) Behavior and attitude of staff at the Canteen
5 4 3 2 1

Q4) Cleanliness of the Canteen
5 4 3 2 1

Q5) Cleanliness of washing area
5 4 3 2 1

Q6) Cleanliness of Tables, Chairs and Utensils
5 4 3 2 1

Q7) Cleanliness of serving personnel
5 4 3 2 1

Q8) Attention provided to you during placing orders
5 4 3 2 1

Q9) Attitude and communication of Canteen Supervisors
5 4 3 2 1

Q10) Promptness in response by Canteen staff
5 4 3 2 1

Q11) How Was the food quality was it upto your expectations
5 4 3 2 1

Q12) Was the food tasty
5 4 3 2 1

Q13) Was the quantity sufficient
5 4 3 2 1

Q14) Was the variety appreciated by you
5 4 3 2 1

Q15) Your feedback on rates/price of the food/snacks
5 4 3 2 1

Q16) Were your complaints handled or heard properly
5 4 3 2 1

Q17) Your overall satisfaction on Canteen Service
5 4 3 2 1

Patient/Attendant's Name

UHID No.

Phone/Mobile No.

Your Email

Comments/Suggestions

IPD

Q1) Availibility of sufficient information at the Registration / Admission counter
54321

Q2) Waiting time at the Registration / Admission counter
54321

Q3) Behavior and attitude of staff at the Registration / Admission counter
54321

Q4) Your feedback on discharge process
54321

Q5) Cleanliness of the wards
54321

Q6) Cleanliness of Bathrooms and Toilets
54321

Q7) Cleanliness of Bed sheets/ pillow covers etc.
54321

Q8) Cleanliness of surroundings and campus drains
54321

Q9) Regularity of Doctor’s attending you or your patient
54321

Q10) Attitude and communication of Doctors
54321

Q11) Time spent for examination of patient and counseling
54321

Q12) Promptness in response by nurses in the wards
54321

Q13) Round the clock availability of Nurses in the ward
54321

Q14) Attitude and communication of Nurses
54321

Q15) Availability , attitude & Promptness of house keeping staff
54321

Q16) All prescribed drugs were they available at the hospital pharmacy
54321

Q17) Were diagnostics services available within the hospital
54321

Q18) Was your diet suppled in time
54321

Q19) Your overall satisfaction during the treatment of your patient in the ward / cabin
54321

Q20) Was the diet provided of good quality
54321

Q21) Did the the Dietician explained your diet in advance
54321

Q22) Cleanliness of the serving personnel
54321

Q23) Your overall satisfaction during the treatment as In-patient
54321

OPD

Q1) Availability of sufficient information at the waiting area
54321

Q2) Wating time at the registration counter
54321

Q3) Behaviour and attitude of hospital Front Office staff
54321

Q4) Behaviour and attitude of hospital OPD Nurses
54321

Q5) Promptness of nurses and Care provided to you by OPD nurses
54321

Q6) Information provided to you by hospital staff about treatment & procedures
54321

Q7) Cleanliness of the OPD and ambience
54321

Q8) Cleanliness of the Bathrooms and toilets
54321

Q9) Attitude and communication of doctors
54321

Q10) Your waiting time for doctor`s consultation
54321

Q11) Time spent for examination and counselling
54321

Q12) Availabilty of lab and radiology test services
54321

Q13) Promptness at pharmacy counter
54321

Q14) Availability of drugs at the pharmacy
54321

Q15) Your overall satisfaction of your visit to the hospital OPD
54321

ICU

Q1) Provision of sufficient information by ICU staff
54321

Q2) Patient was shifted to ICU in time
54321

Q3) Behavior and attitude of ICU staff
54321

Q4) Communication of Nurses to you regarding patient condition
54321

Q5) Communication of ICU Coordinator to you regarding payment & Conselling
54321

Q6) What you feel about the care provided to the patient
54321

Q7) Time taken on discharge process
54321

Q8) Cleanliness of Bed sheets/ pillow covers etc
54321

Q9) Cleanliness of the ICU environment
54321

Q10) ICU equipments used for patient found properly handled and run
54321

Q11) Were your doctors attending your patients in time
54321

Q12) Attitude and communication of Doctors
54321

Q13) All prescribed drugs were available from the Hospital
54321

Q14) Diagnostics services were provided within the hospital
54321

Q15) Diagnostic service results were available within desired time
54321

Q16) How was the treatment to your patient provided in the ICU
54321

Q17) Your overall satisfaction during the treatment of your patient
54321

CANTEEN

Q1) Availability of information at the Counter on the varieties of food available
54321

Q2) Waiting time for food to be served
54321

Q3) Behavior and attitude of staff at the Canteen
54321

Q4) Cleanliness of the Canteen
54321

Q5) Cleanliness of washing area
54321

Q6) Cleanliness of Tables, Chairs and Utensils
54321

Q7) Cleanliness of serving personnel
54321

Q8) Attention provided to you during placing orders
54321

Q9) Attitude and communication of Canteen Supervisors
54321

Q10) Promptness in response by Canteen staff
54321

Q11) How Was the food quality was it upto your expectations
54321

Q12) Was the food tasty
54321

Q13) Was the quantity sufficient
54321

Q14) Was the variety appreciated by you
54321

Q15) Your feedback on rates/price of the food/snacks
54321

Q16) Were your complaints handled or heard properly
54321

Q17) Your overall satisfaction on Canteen Service
54321

Patient/Attendant's Name

UHID No.

Phone/Mobile No.

Your Email

Comments/Suggestions

Priviledge Card

Shanti Memorial Hospital Loyalty Programme

The Shanti Memorial Hospital Loyalty Programme has been designed for our valuable clientele who are willing to entrut us with the health and wellbeing of themselves & their families...