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Name        Mobile No
E-Mail ID        Bill No

Rate the Following


Ambience

Excellent
Good
Average
Poor

Cleanliness

Excellent
Good
Average
Poor

Staff Service

Excellent
Good
Average
Poor
Did your appointment start on time?
How likely are you to recommend the doctor to your family & friends?
Excellent
Good
Average
Poor
How did you payment process?
Excellent
Good
Average
Poor
How was your over all experience at the Hospital?
Excellent
Good
Average
Poor
Comment