A. ADMISSION PROCESS  
1
Information & assistance
Excellent
Good
Fair
Poor
2
Admission process
Quick and simple (<15 min.)
Average wait
Long wait (25 to 35 min.)
Delayed(>35 minutes)
B. ROOM/WARD
1
Cleanliness, hygiene and tidiness
Excellent
Good
Fair
Poor
2
Linen (Dress, bed sheet, pillow cover, curtain towel etc.)
Excellent
Good
Fair
Poor
3
Facilities, decor and comfort
Excellent
Good
Fair
Poor
4
A/C (Room temperature)
Excellent
Good
Fair
Poor
5
Washroom
Excellent
Good
Fair
Poor
 C. MEAL SERVICES  
1
Dietician's advice and explanation
Excellent
Good
Fair
Poor
2
Waiters communication and presentation
Excellent
Good
Fair
Poor
3
Presentation of food
Excellent
Good
Fair
Poor
4
Food temperature
Excellent
Good
Fair
Poor
5
Quality of Food
Excellent
Good
Fair
Poor
6
Serving time of food
Excellent
Good
Fair
Poor
 D. NURSING CARE  
1
Response
Immediate
Prompt
Average
Delayed
2
Courtesy, friendliness and communication
Excellent
Good
Fair
Poor
3
Attitude & empathy of nurses : attention to your needs
Excellent
Good
Fair
Poor
4
Quality of care
Excellent
Good
Fair
Poor
 E. PAIN MANAGEMENT  
1
How well your pain was controlled
Excellent
Good
Fair
Poor
 F. PHYSICLANS CARE  
1
Friendliness and politeness
Pleasant
Friendly
Warm
Indifferent
2
Information and explanation : About proposed treatment plan, side effects and consent
Excellent
Good
Fair
Poor
3
Addressing concerns
Excellent
Good
Fair
Poor
 G. WARD SECRETARY  
1
Attitudes
Pleasant
Friendly
Warm
Indifferent
2
Information and assistance
Excellent
Good
Fair
Poor
 H. BILLING AND CASH COUNTER  
1
Attitude Courtesy and helpfulness
Pleasant
Friendly
Warm
Indifferent
2
Payment process
Quick and simple (<10min)
Average wait (10 to 20 min)
Long wait (21 to 35 min)
Delayed (> 35 minutes)
3
Addressing your queries
Immediate
Prompt
Average
Delayed
4
Detail and accuracy to bill
Excellent
Good
Fair
Poor
 I. DISCHARGE PROCESS  
1
Information & explanation : Home Care
Excellent
Good
Fair
Poor
2
Discharge process
Quick and simple (< 1 hr.)
Average wait (1 to 2 hr.)
Long wait (2 to 3 hr.)
Delayed (> 3 hr.)
 J. OVERALL EXPERIENCE        
  Overall experience of services
Excellent
Good
Fair
Poor
           
 K. WILL YOU COME TO THIS HOSPITAL FOR FUTURE TREATMENT?
Yes
No
   
 
 L. WILL YOU RECOMMEND THIS HOSPITAL TO OTHERS?
Yes
No
   
 
 M. HOW HAVE YOU COME TO KNOW ABOUT EVERCARE HOSPITAL DHAKA?
Friends/relatives
Media
Website, Facebook, etc.
Referred by community physician
Other clinics/hospitals
Others
 
PLEASE INCLUDE YOUR NAME & CONTACT INFORMATION
*Patient's Name
*Contact Number:
*Email:
UHID:
Date of birth:
Bed number during stay:
Note: You must fill the * marked fields to submit this form.

 

If you have any further feedback, please e-mail us to info@evercarebd.com.