Patient Feedback Form
Personal Information
Name
Date
Admission Number
Feedback
How was your experience at our rehabilitation center?
How would you rate the quality of rehabilitation services you received?
Excellent
Good
Average
Poor
How would you rate the staff's professionalism and support?
Excellent
Good
Average
Poor
How would you rate the cleanliness and facilities?
Excellent
Good
Average
Poor
Suggestions for Improvement
Additional Comments