Patient Satisfaction and Feedback Form

We highly value your feedback on your experience with our practice, as it helps us enhance the quality of care we provide. As part of our commitment to safe, high-quality healthcare, we actively welcome your input to continuously improve our services and better meet your needs. Please take a moment to complete this quick 3-minute survey by selecting the most appropriate response for each statement and sharing your experience with us. Takes about three minutes.
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General information

All fields below are optional. Share what you'd like — we only ask so the Ministry can follow up if you've requested a response.

Your name optional

ID number NID / PP / hospital no.

Department or ward optional

Date of visit optional

Contact number optional

Type of service optional

Patient Satisfaction survey

Twenty-eight short statements across five service areas. Each on a five-point scale; some allow N/A if the question does not apply to your visit.

Feedback

Optional — share what stood out, who deserves recognition, or what could be better.

Please describe any areas of excellence or outstanding service that you received.

Name of Staff We want to recognize and acknowledge good staff and excellent service. Please let us know if our staff left an expression on you.

Please describe any inconvenience you faced or suggest ways we could improve our hospital services

Anything you entered above is visible only to Ministry of Health staff reviewing the response. We do not share or publish it.