EK-10 | INTERNATIONAL PATIENT FEEDBACK SYSTEM | ENGLISH

INTERNATIONAL PATIENT SATISFACTION SURVEY

Measuring the service experience and open feedback

1 Record & Patient Details

Survey Date

Patient / File No (Optional)

Nationality / Preferred Language *

Service / Department *

Application Route

Direct Facility Channel Intermediary Agency

Survey Method

Digital Paper Phone In Person

A Satisfaction Assessment

Please rate each statement from 1 to 5: 1 Very poor, 2 Poor, 3 Fair, 4 Good, 5 Very good, N/A Not applicable. Responses are reviewed to improve service quality.

1. Ease of enquiry and appointment process

1 2 3 4 5 N/A

2. Clarity of pre-treatment information

1 2 3 4 5 N/A

3. Clarity of prices, payment and extra costs

1 2 3 4 5 N/A

4. Adequacy of interpreter/language support

1 2 3 4 5 N/A

5. Organization of admission and registration

1 2 3 4 5 N/A

6. Communication of physicians and staff

1 2 3 4 5 N/A

7. Explanation of diagnosis, treatment, risks and alternatives

1 2 3 4 5 N/A

8. Protection of privacy and personal data

1 2 3 4 5 N/A

9. Cleanliness, hygiene and physical conditions

1 2 3 4 5 N/A

10. Waiting times and timeliness of service

1 2 3 4 5 N/A

11. Travel/accommodation/transfer coordination (if any)

1 2 3 4 5 N/A

12. Adequacy of discharge information and documents

1 2 3 4 5 N/A

13. Post-discharge follow-up and accessibility

1 2 3 4 5 N/A

14. Overall satisfaction

1 2 3 4 5 N/A

Recommendation: How likely are you to recommend this healthcare facility?

0 1 2 3 4 5 6 7 8 9 10

0 - Not likely at all 10 - Extremely likely

B Opinion, Suggestion & Feedback

Submission Type

Compliment Opinion Suggestion Complaint Other

What was the most positive part of your experience?

What should be improved / description of complaint:

Response Preference

No Response Phone E-mail WhatsApp

Contact Info (Phone / Email / WhatsApp)

I agree that my information may be used to evaluate this feedback and contact me regarding my patient experience with Op. Dr. Murat Melih Can.

Op. Dr. Murat Melih Can - Aesthetic & Plastic Surgery Specialist

✓

Thank You Very Much!

Your satisfaction feedback has been recorded successfully. Your responses help Op. Dr. Murat Melih Can and team maintain the highest standards of international patient care.