Patient Feedback Form
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Gender
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Birth Date
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Month
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31
Day
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Year
Overall satisfaction
Rows
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Doctor Knowledge
1
2
3
4
5
Doctor Kindness
6
7
8
9
10
Nurse Patience
11
12
13
14
15
Nurse Knowledge
16
17
18
19
20
Waiting Time
21
22
23
24
25
Hygiene
26
27
28
29
30
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