Patient Name * :		Phone * :
	Email * :		Investigation :
	UID No * :		Address :

1. Whether our staff is courteous in dealing with you & sincere     in their working?		Excellent Satisfactory Needs Improvements
2. Your perception of maintenance of our machines     and departments?		Excellent Satisfactory Needs Improvements
3. Compliance to committed time of report delivery?		Excellent Satisfactory Needs Improvements
4. Overall performance compared to other health     establishments?		Excellent Satisfactory Needs Improvements

	Feedback/Suggestions* :

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