Apollo Hospitals Dhaka

A. APPOINTMENT CALL CENTRE

1

Response in answering call

Immediate

Prompt

Average

Delayed

2

Courtesy of operator

Excellent

Good

Fair

Poor

3

Communication : Usefulness of Information

Excellent

Good

Fair

Poor

B. REGISTRATION PRODESS

1

Information and assistance

Excellent

Good

Fair

Poor

2

Registration Process

Quick and simple (>10 min)

Average wait (10 to 15 min)

Long wait (16 to 29 min)

delayed (>29 min)

C. MEDICAL SECRETARY

1

Attitude

Pleasant

Friendly

Warm

Indifferent

2

Information and assistance

Excellent

Good

Fair

Poor

D. PHYSICIANS' CARE

1

Friendliness and politeness

Pleasant

Friendly

Warm

Indifferent

2

Information and explanation : About diseases, treatment & other concerns

Excellent

Good

Fair

Poor

3

Addressing concerns

Excellent

Good

Fair

Poor

E. BILLING AND CASH COUNTER

1

Attitude, Courtesy and helpfulness

Pleasant

Friendly

Warm

Indifferent

2

Payment Process

Quick and simple (<10 min)

Average wait (10 to 15 min)

Long wait (16 to 29 min)

Delayed (>29 min)

F. INVESTIGATION/SAMPLE COLLECTION

1

Information & explanation

Excellent

Good

Fair

Poor

2

Investigation/sample collection procedure

Quick and simple

Average wait

Long wait

Delayed

3

Report delivery

Excellent

Good

Fair

Poor

G. ENVIRONMENT

1

Cleanliness, hygiene and tidiness

Excellent

Good

Fair

Poor

2

Facilities, decor: signage, directions

Excellent

Good

Fair

Poor

3

Temperature comfort and sitting arrangement

Excellent

Good

Fair

Poor

4

Cleanliness of washrooms

Excellent

Good

Fair

Poor

H. PHARMACY

1

Attitude : Courtesy and helpfulness

Pleasant

Friendly

Warm

Indifferent

2

Communication by pharmacist

Excellent

Good

Fair

Poor

3

Medicine delivery time

Quick and simple (<10min)

Average wait (10 to 20 min)

Long wait (21 to 35 min)

Delayed (> 35 min)

4

Availability of medicines

Excellent

Good

Fair

Poor

I. OVERALL EXPERIENCE

1

Overall experience of services

Excellent

Good

Fair

Poor

J. WILL YOU COME TO THIS HOSPITAL FOR FUTURE TREATMENT?

Yes

No

K. WILL YOU RECOMMEND THIS HOSPITAL TO OTHERS?

Yes

No

L. HOW HAVE YOU COME TO KNOW ABOUT APOLLO HOSPITALS DHAKA?

My friends/relatives
Learn from media
Internet
Referred by community physician
Other clinic/hospital
Others

M. ANY COMMENTS/SUGGESTIONS THAT WILL HELP US TO IMPROVE THE CARE WE PROVIDE?

PLEASE INCLUDE YOUR NAME & CONTACT INFORMATION

*Patient's Name
*Contact Number:
*Email:
UHID:
Bed:
Date of birth:

Note: You must fill the * marked fields to submit this form.