dashboard1 CLIENT SURVEY FORM Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date *1. How often do you get services at Our Institute? *a) First timeb) More than once2. i) How have we served you today? *a) Very goodb) Goodc) Poord) Very poore) Not served yetii) If your response is poor or very poor, kindly mention the service point and reason *iii) If your response is good or very good, kindly mention the service point *3. (i) Could you rate the cleanliness of our Institute? *a) Very cleanb) Cleanc) Dirtyd) Very dirty(ii) If your response is dirty or very dirty, kindly mention the areas4. (i) Could you rate our customer care service? *GoodFairPoor(ii) If your response is poor, please tell us the awful language that tripped you up and mention the service point 5. Have you ever been asked for a bribe at any service receiving point? *YesNo6. Please tell us any other challenges you faced while receiving services7. How long didi you wait before being attended to by relevant healthcare profeessional? *Too longShort time any reason your 8. Which employee served you well and from which section?SUBMIT BACK
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