- Tun Hussein Onn National Eye Hospital

THONEH / CUS/ FRM / 01-03
L.
K.
CUSTOMER SATISFACTION
ilt
o
H
Please tell us about yourself
n
FE
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P.
J
ER
.
AL
H
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W
AY
A
LR sia
T Ja
St ya
at P
io u
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on
A
H r ma
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ta
COMMENTS
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m
ra
B
SN:(Internal use only)
fo
Poor
U
Average
Very Poor
n
la
Good
Ja
Excellent
T
O he T
n
Ey n un
e Na H
Ho ti us
Lo
ro
sp ona se
ng
ita l in
U
l
ta
Generally, how did our hospital meet your expectations?
Ja
n
la
Ba
ra
Why did you choose The Tun Hussein Onn National Eye Hospital?
ke
G
Su ian
pe t
rm
ar
Kl
an
rt
Our location/image
Po
Family/friends recommendation
Previous experience here
t
g
t
My doctor’s recommendation
On behalf of the management and staff, we thank you for
completing this Patient Feedback and choosing
The Tun Hussein Onn National Eye Hospital.
Others, please explain
Is this your first visit to our hospital?
Yes
No
Would you recommend our hospital to your friends/relatives?
Yes
Name:
Address:
Contact No.:
Date:
No
The Tun Hussein Onn National Eye Hospital
Lorong Utara B, 46200 Petaling Jaya,
Selangor Darul Ehsan
Postal : P.O.Box 514, Jalan Sultan Post
Office, 46760 Petaling Jaya.
Tel : 603-7718 1488 Fax : 603-79576128
E-mail : [email protected]
Website : http://www.thoneh.com.my / thoneh.com
We welcome your feedback and
suggestions to help us continuously
improve our quality of services
We would greatly appreciate if you could take a few minutes to fill in this form and drop it into our suggestion box.
Your feedback is important in helping us to continuously improve our INPATIENT SERVICES
Registration
Excellent
Good
Average
Poor
Very Poor
Doctors
Waiting time to
Polite & Courteous
be admitted
Professionalism
Admission Precedure
Overall Impression
Overall Impression
Other comments :
Excellent
Good
Average
Poor
Very Poor
Excellent
Discharge
Waiting time for biling
Excellent
Good
Average
Poor
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Polite & Courteous
Overall Impression
Day Care
Room
Good
Waiting Time
Very Poor
Polite & Courteous
Cleanliness of room
Cleanliness of bathroom
Nurses
Environment
Polite & Courteous
Overall Impression
Professionalism
Excellent
Good
Average
Poor
Very Poor
Friendly & Helpful
Overall Impression
Overall Impression
Other comments :
Operating Theatre
Food
Excellent
Good
Average
Poor
Waiting Time
Very Poor
Quality
Polite & Courteous
Quantity
Friendly & Helpful
Variety
Overall Impression
Presentation
Quality of Care
Taste
Doctor
Warmth
Nurse
Explanation
Excellent
Good
Average
Poor
Very Poor
L.
K.
CUSTOMER SATISFACTION
ilt
o
H
Please tell us about yourself
n
FE
D
P.
J
ER
.
AL
H
IG
H
W
AY
A
LR sia
T Ja
St ya
at P
io u
n tra
Is
ta
ra
C
on
A
H r ma
ot d
el a
ra
m
ta
COMMENTS
in
iu
m
ra
B
SN:(Internal use only)
fo
Poor
U
Average
Very Poor
n
la
Good
Ja
Excellent
T
O he T
n
Ey n un
e Na H
Ho ti us
Lo
ro
sp ona se
ng
ita l in
U
l
ta
THONEH / CUS/ FRM / 02-03
Generally, how did our hospital meet your expectations?
Ja
n
la
Ba
ra
Why did you choose The Tun Hussein Onn National Eye Hospital?
ke
G
Su ian
pe t
rm
ar
Kl
an
rt
Our location/image
Po
Family/friends recommendation
Previous experience here
t
g
t
My doctor’s recommendation
On behalf of the management and staff, we thank you for
completing this Patient Feedback and choosing
The Tun Hussein Onn National Eye Hospital.
Others, please explain
Is this your first visit to our hospital?
Yes
No
Would you recommend our hospital to your friends/relatives?
Yes
Name:
Address:
Contact No.:
Date:
No
The Tun Hussein Onn National Eye Hospital
Lorong Utara B, 46200 Petaling Jaya,
Selangor Darul Ehsan
Postal : P.O.Box 514, Jalan Sultan Post
Office, 46760 Petaling Jaya.
Tel : 603-7718 1488 Fax : 603-79576128
E-mail : [email protected]
Website : http://www.thoneh.com.my / thoneh.com
We welcome your feedback and
suggestions to help us continuously
improve our quality of services
We would greatly appreciate if you could take a few minutes to fill in this form and drop it into our suggestion box.
Your feedback is important in helping us to continuously improve our OUTPATIENT SERVICES
Registration
Excellent
Good
Average
Poor
Very Poor
Central Booking Centre Excellent
Waiting Time
Waiting Time
Polite & Courteous
Polite & Courteous
Friendly & Helpful
Friendly & Helpful
Overall Impression
Overall Impression
Vision-taking
Excellent
Good
Average
Poor
Very Poor
Photography/FFA
Good
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Public Areas
Cleanliness
Excellent
Good
Average
Poor
Very Poor
Excellent
Good
Average
Poor
Very Poor
Quality of Care
Doctor
Nurse
Explanation
Treatment
Excellent
Good
Average
Poor
Very Poor
Pharmacy
Waiting Time
Waiting Time
Waiting Time
Polite & Courteous
Polite & Courteous
Polite & Courteous
Friendly & Helpful
Friendly & Helpful
Friendly & Helpful
Overall Impression
Overall Impression
Explanation
Overall Impression
Visual Fields
Excellent
Good
Average
Poor
Very Poor
Orbscan
Excellent
Good
Average
Poor
Very Poor
Waiting Time
Waiting Time
Cashier
Polite & Courteous
Polite & Courteous
Polite & Courteous
Friendly & Helpful
Friendly & Helpful
Efficent & Prompt
Overall Impression
Overall Impression
Overall Impression
Refraction/Optometry Excellent
Good
Average
Poor
Very Poor
O.C.T.
Excellent
Good
Average
Poor
Very Poor
Waiting Time
Waiting Time
Polite & Courteous
Polite & Courteous
Friendly & Helpful
Friendly & Helpful
Food
Overall Impression
Overall Impression
Quality
Quantity
Orthoptics
Excellent
Good
Average
Poor
Very Poor
LASIK Centre
Excellent
Good
Average
Poor
Very Poor
Variety
Waiting Time
Waiting Time
Presentation
Polite & Courteous
Polite & Courteous
Taste
Friendly & Helpful
Friendly & Helpful
Warmth
Overall Impression
Overall Impression
Minor Theatre
Waiting Time
Polite & Courteous
Friendly & Helpful
Overall Impression
Excellent
Good
Average
Poor
Very Poor