Children's Feedback Form


My visit today Made me feel	Really Good	Good	Average	Unhappy
1) Reception	Really Good	Good	Average	Unhappy
a) Telephone Information	Really Good	Good	Average	Unhappy
b) Registration	Really Good	Good	Average	Unhappy
c) Explanation about the procedure	Really Good	Good	Average	Unhappy
2) Standard of Cleanliness	Really Good	Good	Average	Unhappy
3) Staff Communication & Behaviour	Really Good	Good	Average	Unhappy
4) Consultation related to medicak problem	Really Good	Good	Average	Unhappy
5) Facilities & Technology	Really Good	Good	Average	Unhappy
6) My idea's to make the hospital better
My Name and Address (Optional)