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Siby Palatty

This document is a questionnaire from Century Hospital pharmacy department to improve their outpatient services. It requests the respondent provide their name, age, gender, nationality, education level, marital status, how they heard of the hospital, and if this is their first visit in order to collaborate with the pharmacy and better serve patients.

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Century Hospital The purposeof this form is to improve the OP pharmacy process to serve you better. Therefore, I request you to collaborate with me by filling the questionnaire given below using the following attributes: 1. Name : _______________________ 2. Age (In Years) : ________________________ 3. Gender : Male Female 4. Nationality : Indian Others (Specify) __________________ 5. Educational Qualification: ? Below matriculation ? Matriculation ? Higher Secondary ? Degree and above 6. Marital Status : Married Single 7. Sourceof information about Century Hospital: ? Advertisement ? Friends & Relatives ? Doctors Reference ? Others Specify...................................................... 8. Is this your first visit to Century Hospital: Yes No

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  • 1. Century Hospital The purposeof this form is to improve the OP pharmacy process to serve you better. Therefore, I request you to collaborate with me by filling the questionnaire given below using the following attributes: 1. Name : _______________________ 2. Age (In Years) : ________________________ 3. Gender : Male Female 4. Nationality : Indian Others (Specify) __________________ 5. Educational Qualification: ? Below matriculation ? Matriculation ? Higher Secondary ? Degree and above 6. Marital Status : Married Single 7. Sourceof information about Century Hospital: ? Advertisement ? Friends & Relatives ? Doctors Reference ? Others Specify...................................................... 8. Is this your first visit to Century Hospital: Yes No