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Patient Satisfaction Feedback Form
Thyrocare’
Think Thyroid. Think Thyrocare.
“Thyrocare Technologies Limited : 0-37/1, TTC Industral Area, MIDC, Turbine, Navi
‘Mumba - 400705, Tol (022) 2762 2762 4125 4125, Website: [Link]
Email: nfo@[Link]
Date:
Source Code:
PATIENT NAME AGE
ADDRESS :
i:
Telephone No: Email
1. How did you come to know about Thyrocare?
Doctors Labs Booklets /advertisments
2. What were the tests you got done?
Thyroid ‘Aarogyam SugarScan
3, Do you come across ‘Thyrocare - Advertisement’ campaigns?
Yes No
4, Ifyes, how do you rate it?
Average Good Very Good
5, Could you locate the centre easi
Yes No
6, Do you appreciate the rates charged at Thyrocare?
Yes No
you informed on the date of reporting?
Yes No
Others
Others
Excellent
12 1. In how many days you could get the reoprts?
Next day Within 2 days Within 5 days More than 5 days
2. Did you receive your reports in time?
Yes No
3. What was the mode of report delivery?
Collected
at center
Home Delivery Courier / Post
4, How do you rate the quality and presentation of our report?
Average Good Very Good Excellent
5. How do you rate the ambience of the collection centre?
Average Good Very Good Excellent
6. In what time were you attended?
Less thant min 15-30 min 33-36 min 45 min
7. What was the level of courtesy of the staff?
Average Good Very Good Excellent
8. Aro you satisfied with the service provided by Thyrocare?
Yes No
9. Would you recommend others to use Thyrocare service?
Yes No
‘Suggestions:
Signature Date
212
