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Exit Survey
 
 
Name
   
 
 
 
Gender
 
 
 
Age
 
18-25
 
26-40
 
41-60
 
60 above
 
 
 
what are the factors that influence you choose a hospital?
 
self
 
spouse
 
joint
 
family
 
 
 
what are the sources you prefer to gather information before choosing a hospital?
 
advertisement
 
family
 
friend
 
family doctor
 
any other
 
 
 
during the hospital visit was the area around you kept clean & quiet?
 
yes
 
sometimes
 
no
 
 
 
do you feel private hospital is comfortable you to stay?
 
yes
 
no
 
 
How satisfied are you with the following 
strongely agree agree neutral disagree strongly disagree
hospital utilise upto date appratus & equipments
hospital provide services as promised
behaviour of nurses & staff is appropriate towards patients
attitude of doctors their patients is good
 
 
How satisfied are you with the following:
strongly agree agree neutral disagree strongly disagree
nursing staff handling patients with respect & dignity
hospital personnel sociable& caring
patients feel secure & protected in custody of hospital workforce
 
 
 
would you recommend this hospital to your friends & family?
 
yes
 
maybe
 
no