*I.P.D. NO.

At Sahasrabudhe Hospital & ICCU we are committed to Provide highest Standard of care. To Achieve this we require Feedback on the service we provide. Please place appropriate number in the box given below. Which best describes your experience during your hospital stay. If you wish to make specific suggestions, please do so in the space provided. All responses will be confidential.

*Rating numbers as follows :

Pre admission
* 1. Did you receive adequate information from the reception counter?
*2. Did you feel the staff was prompt in responding to your needs?
*3. Did you receive appropriate discharge instructions and Follow up care from your Doctor & Nurses?
*4. Are you satisfied with the cleanliness of the hospital?
*5. Overall how satisfied were you with the care received at Sahasrabudhe Hospital & lCCU?

*6. Please write your comments / suggestions if you wish to for further improvement in the standard of the hospital ?

* 7. Name of the staff with better performance ?

*Date