Mom & Me - Patient Feedback Form Name (required) Mobile Number (required) 1. How did you get to know about us? * FriendPractoDoctorSocial mediaOthers If others (Pls elaborate) 2. How easy was it to fix an appointment with us? * Very easyEasyNeither easy nor difficultDifficultVery difficult If difficult (please specify) 3. How would you rate the accessibility to our center? * Excellent accessEasily accessibleFound it difficult to locateExtremely difficult If difficult (please specify) 4. How did you find our registration process? * Very smoothEasyA bit difficultComplicated If difficult (please specify) 5. What was the service you availed with us? * Fetal medicine ultrasoundGynecologyOrthoPediatricsRadiology servicesPhysiotherapyNutrition & DieteticsGeneral MedicineLab servicesPharmacy 6. How do you rate our Doctors on the following grounds? * InformativeSkilledCourteousPunctualExplanativeNone of the above 7. How was your experience with our front desk executive? * Needs improvementAverageGoodVery goodExcellent Needs improvement (please specify) 8. How would you rate our ambience? Needs improvementAverageGoodVery goodExcellent For Improvement (please specify) 9. Would you recommend our services to your friends & family? * yesNo 10. How was your overall experience with us? * ExcellentGoodAverageNeeds improvement For Improvement (please specify) 11. Can you drop your suggestions as to how we could improve our services?