NICC Survey Form

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Survey Form

Pinuntahang Office/Department/Room #:

Kawani o Staff na nag bigay ng serbisyo:

Pakay o Sadya sa pag punta dito:

Tagal ng paghihintay bago matugunan ang pangangailangan:

Oras: Minuto:

Sa kabuuan, kontento ka ba sa serbisyo/impormasyon na inyong natanggap?

Oo Hindi

Natanggap ang serbisyong kailangan:

Mabilis at maagap ang serbisyo:

Ang kawani ay may sapat na kaalaman:

Ang kawani ay magalang at madaling lapitan:

Patas, tapat at sapat ang serbisyong ibinigay:

Malinis at maayos ang pasilidad:

Komento / Suhestiyon

Contact Information (Optional)

Fullname

Contact Number

Please fill out all fields marked with an asterisk (*).

Data Privacy Notice

The personal information and data collected in this form is used for NICC's service improvement and to communicate with patients/companions, as needed. All information collected through this form are stored in a secure location in NICC, accessed by authorized staff. No data is shared with any external group. Data collected will be deleted one year from date of accomplishment.