FEEDBACK FORM /
BORANG MAKLUMBALAS
Your Personal Details
Maklumat Peribadi Anda
Full Name
(Required)
Nama Penuh
First
Nationality
(Required)
Warganegara
Phone No.
No. Telefon
Email
Emel
Patient Details
Maklumat Pesakit
Patient Name
(Required)
Nama Pesakit
Room Number
(Required)
Nombor bilik
Name of Doctor
(Required)
Nama Doktor
Check-in Date
(Required)
DD slash MM slash YYYY
Tarikh Masuk
Check-out Date
(Required)
DD slash MM slash YYYY
Tarikh Keluar
Relationship with Patient
Hubungan dengan Pesakit
Self / Diri Sendiri
Spouse / Pasangan
Next of kin / Keluarga terdekat
Guardian / Penjaga
Age
Umur
Under 18 years old / Bawah 18 tahun
18 - 30 years old / tahun
31 - 40 years old / tahun
41 - 60 years old / tahun
Above 60 years old / 60 tahun ke atas
Your Feedback
Maklumbalas Anda
What is your main reason to choose Naluri Hospital?
Apakah sebab utama anda memilih Hospital Naluri?
Friends or Family recommendation / Cadangan kawan atau keluarga
Hospital reputation / Reputasi hospital
Expertise in specific illness @ treatment / Kepakaran dalam penyakit @ rawatan tertentu
Reasonable pricing / Harga berpatutan
Services quality / Kualiti perkhidmatan
Public information (social media, website, marketing publicity, etc) / Maklumat awam (media sosial, laman web, publisiti pemasaran, lain-lain)
Doctor referral / Rujukan doktor
Panel @ Insurance requirements / Keperluan panel @ insurans
Hospital facilities & amenities / Kemudahan & kelengkapan hospital
How did you know about us?
Bagaimana anda tahu tentang kami?
Colleagues
Events
Facebook
Instagram
Google / Website
Family members
Friends
Recommended by Naluri's staff
Referred by GP
Rating System (%)
Sistem Penilaian (%)
N/A - Not Applicable /
Tidak berkenaan
1 - Non-satisfactory /
Tidak memuaskan
2 - Poor /
Lemah
3 - Average /
Sederhana
4 - Good /
Baik
5 - Excellent /
Cemerlang
Ease of getting care
Kemudahan mendapatkan penjagaan
Waiting Time
Masa Menunggu
Hospital Facilities & Amenities
Kemudahan Hospital
Nurse(s)
Jururawat
If there is one (1) thing Naluri Hospital could do to make your experience delightful, what would it be?
Apakah satu (1) perkara yang boleh dilakukan oleh Hospital Naluri untuk menjadikan pengalaman anda lebih bermakna?
