Inpatient Service Quality Feedback Form

Page 1

Comments and Suggestions

Please let us know more about yourself

Share with us how we have performed well or how can we improve to serve you better.

Name (Patient):

(optional)

NRIC (Patient): I stay in Ward: Your Name (if you are relative/friend):

Contact No. : Email Address:

-

Date of Feedback: day

month

year

Please drop this in the Feedback Box or return to: Khoo Teck Puat Hospital 90 Yishun Central Singapore 768828 Main line: (65) 6555 8000 www.ktph.com.sg

KTPH.IP.GN.01.1017

Inpatient Service Quality

Feedback Form


Thank you for choosing

Khoo Teck Puat Hospital. It is our desire to provide a level of care and service good enough for our own mothers without the need for special arrangements. Your comments and feedback are important to us. Please take a few minutes to share how we can further improve to serve our patients better. We wish you and your family the best of health always. Chew Kwee Tiang (Mrs)

Excellent Good

Fair

Poor Very poor

Excellent Good

Doctors

Admission Services

Knowledge & Skills Care & Concern Clear Explanation

Prompt & Courteous Clear Explanation

Nurses

Helpful & Courteous Clear Explanation

Knowledge & Skills Care & Concern Clear Explanation (Physiotherapist, Occupational Therapist & Speech Therapist)

Knowledge & Skills Care & Concern Clear Explanation

Environment Cleanliness Comfort Clear Signage

Meals Taste Temperature Presentation

(Dietician, Medical Social Worker)

Discharge Services

I am a:

Knowledge & Skills Care & Concern Clear Explanation

Pharmacist

Overall Service

Visitor

Relative of patient

(please specify, e.g. Father)

Yes, you may contact me for more information when necessary. I would like to attend the patient focus group.

Knowledge & Skills Care & Concern Clear Explanation

Others

(Health Care Assistant, Patient Service Assistant)

This feedback is a:

Compliment Complaint Suggestion

Knowledge & Skills Care & Concern Clear Explanation

Poor Very poor

Financial Counselling

Do share your experiences with us. Please shade ( ) the appropriate circles.

Patient

Fair

Prompt & Courteous Clear Explanation

What was your overall experience? Better Slightly Neither Slightly Worst than above above below than expected expectation or below expectation expected exception

Would you recommend our hospital to others? Strongly

Likely

Neither will nor will not

Unlikely

Will not


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