Lob & Complaints - Form

Patient
feedback sheet

Feedback sheet

    Dear patient, Dear patient

    Your opinion is important to us. For this reason, we ask you to give us a short feedback on your hospital stay, so that we can better adapt to your wishes and needs.

    The data in the questionnaire are only collected for statistical purposes in the context of quality assurance. We guarantee that personal data will not be passed on to third parties or can be viewed by third parties.

    Personal information

    Name

    Your e-mail address*

    Age*

    Gender*

    hospitalisation

    Date of

    Date to

    In which station were you located?*

    Which station was responsible for you?*

    Were you welcomed at the information?

    The reception in the patient reception was friendly?

    Have you been informed about the possibility of elective performance?

    Did the hospital make a clean impression?

    Please assess:

    medical care

    nursing care

    ambulance

    ECG

    endoscopy

    physiotherapy

    X-ray department

    Soziel service

    Central OP

    circle of helpers

    They support us in our efforts to provide you and all other patients with the best possible care.

    What did you particularly like or not like at all?

    What suggestions for improvement can you make to us?

    Please rate our food:

    taste

    Serving size

    variety

    How did you become aware of us or the district clinic?

    Would you recommend our district clinic?

    Thank you for the feedback, please download the Google reCAPTCHA before submitting the form

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