Patient Feedback Form

Patient's Name

Sex
MaleFemaleOther

Age

Location
Borivali (W)Laboratory - Dahisar (W)Dahisar (E)AshokvanM.M. Hospital - I.C. Colony

Date of Visit

Services Opted
Blood TestSonographyX-RayDoctor's ConsultationAudiometryTMTAdmissionSurgery2D-EchoOthers (please specify below)

[label]If 'Others', please specify

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⭐ Rate Our Services (1 to 6 Stars)

Center Cleanliness
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Service
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Waiting Time
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Overall Experience
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Any Other Comments