Patient Feedback Form – Benin Medical Care
Your Information
Full Name
Phone Number
Email Address
1. Overall, how would you rate your experience at Benin Medical Care?
*
☆
☆
☆
☆
☆
2. Which service did you receive?
*
General Consultation
Specialist Care
Laboratory / Diagnostics
Pharmacy
Inpatient Care
Emergency Services
Others
3. If Others (please specify)
4. How would you rate the professionalism of our staff?
*
Excellent
Good
Fair
Poor
5. Was our environment clean and comfortable?
*
Yes
No
6. Did you receive clear communication and attention from our team?
*
Yes
No
Partially
7. How long did you wait before being attended to?
*
Less than 15 minutes
15–30 minutes
30–60 minutes
Over 1 hour
8. Would you recommend Benin Medical Care to others?
*
Yes
No
9. Additional comments or suggestions
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