Feedback form - MIOT Rehab Centre Name* MR No* User Type Select Patient Attender Family Member Ward / Bed No* Contact Number* Email Duration Of Stay* Date Of Visit* How did you come to know about MIOT Hospitals?* Select Option Apartment Digital Screen Auto Wrap Brochure Bus Back Panel Bus Stop Shelter Bus Wrap Corporate Display Email Facebook Google Ads Google Search Hoardings Instagram Internal Doctor Referral Internal Standee Leaflet LED Screen LinkedIn Magazine Newspaper Newspaper Insert Poster Radio SMS Telegram Theatre TV Viber Walk-in Webinar Website Banner Ad WhatsApp Word of Mouth YouTube Please rate your experience in the following areas. Excellent Very Good Good Fair Poor How satisfied are you the facilities inside the rehab centre? Equipments available*: 5 stars 4 stars 3 stars 2 stars 1 star Cleanliness & Sanitization*: 5 stars 4 stars 3 stars 2 stars 1 star Maintenance of equipments & availability for use*: 5 stars 4 stars 3 stars 2 stars 1 star Competence of the Rehab doctor? How satisfied are you with the competence of the Rehab doctor?*: 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with the competence of our Rehabilitation team? (Rate only relevant services) Physiotherapist: 5 stars 4 stars 3 stars 2 stars 1 star Speech Language Pathologist: 5 stars 4 stars 3 stars 2 stars 1 star Occupational Therapist: 5 stars 4 stars 3 stars 2 stars 1 star Psychologist: 5 stars 4 stars 3 stars 2 stars 1 star Respiratory Therapist: 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with the Nursing Staff? Immediate response to your queries/call for help*: 5 stars 4 stars 3 stars 2 stars 1 star Timely Medication & care*: 5 stars 4 stars 3 stars 2 stars 1 star Empathetic & helpful at all times*: 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with Treatment Process for Rehabilitation? Experts explaining the Treatment plan*: 5 stars 4 stars 3 stars 2 stars 1 star Explaining Treatment duration/Timeline*: 5 stars 4 stars 3 stars 2 stars 1 star Timely delivery of Treatment*: 5 stars 4 stars 3 stars 2 stars 1 star Experts discussing the progress regularly*: 5 stars 4 stars 3 stars 2 stars 1 star Rehabilitation Team members How satisfied are you with the behaviour of our Rehabilitation Team members towards you? *: 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with the Diet? Food Quality and Taste *: 5 stars 4 stars 3 stars 2 stars 1 star On time Food service *: 5 stars 4 stars 3 stars 2 stars 1 star Nutritionist regular assessment of patient's nutritional needs *: 5 stars 4 stars 3 stars 2 stars 1 star Dieticians attitude towards understanding the patient's preferences/choices of food*: 5 stars 4 stars 3 stars 2 stars 1 star Discussing about change in food item/menu*: 5 stars 4 stars 3 stars 2 stars 1 star House keeping How satisfied are you with the House keeping services? (Daily Cleaning Room/Toilet, changing bed linens) 5 stars 4 stars 3 stars 2 stars 1 star Maintenance How satisfied are you with the maintenance facilities? (Effectiveness of Air conditioning, Lighting, Television, toilet accessibility) 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with the shifting arrangements to Rehab Centre from the ward? Timely Shifting 5 stars 4 stars 3 stars 2 stars 1 star Safety aspects in shifting 5 stars 4 stars 3 stars 2 stars 1 star Availability and maintenance of transfer equipments (Wheelchair, stretchers) 5 stars 4 stars 3 stars 2 stars 1 star Behaviour of helper boys 5 stars 4 stars 3 stars 2 stars 1 star How satisfied are you with convenience of our admission, stay and discharge process? PRO's explanation of the process 5 stars 4 stars 3 stars 2 stars 1 star PRO completing the process in time 5 stars 4 stars 3 stars 2 stars 1 star PRO's approach during the course of stay in hospital 5 stars 4 stars 3 stars 2 stars 1 star Overall Satisfaction How satisfied are you with the overall outcome of rehabilitation? 5 stars 4 stars 3 stars 2 stars 1 star How likely are you to recommend our services How likely are you to recommend MIOT rehabilitation services to your friends and family? 5 stars 4 stars 3 stars 2 stars 1 star Do you have any complements or suggestions to improve our service?*
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