Please let us know your opinion(Outpatient)

We are going to make this Center a much better hospital based on your opinion.
We would appreciate it very much if you could point out anything you felt to us during your visit here.
Please not that all fields followed by an asterisk must be filled in.
Medical Information
Questionnaire No. 
Please input without hyphens.
(Example) In the case of 0228-001, input 0228001.
Date of your visit 
(Example)In the case you visited on November 1, 2020, input 20201101.
Department you visited today 
If you visited more than 1 department, please write the first department you visited.
Why did you choose this Center? Please circle everything that applies. 
If you choose others, please input the following items.
The reason you chose others 
Easy to understand signs 
Waiting spaces 
Toilet/sink area 
Coffee shop 
Parking lot 
Environment / Services(5…Very satisfied 4…Satisfied 3…Neither satisfied, nor dissatisfied 2…Dissati
Waiting time for blood collection 
Waiting time for consultation 
Waiting time at a cashier 
Waiting time for in-hospital pharmacy 
Safety measures 
Information offered through posters and brochures 
Good communication and cooperation among staff 
Did you receive sufficient explanation from the doctors about the diagnosis and treatment plan of yo 
Ease of asking questions to the doctors 
Explanation and manners of the nurses and midwives 
Ease of asking quesitons to the nurses and midwives 
Hospitality (Wording and manners)
X-ray technologists 
Laboraory technologists 
Registered nutritionists 
First Visit receptionists 
Accounting and Outpatient Cashier 
General Information staff 
Receptionists of each department 
Volunteer staff 
Security staff 
Comprehensive evaluation総合評価(5…とても満足、4…やや満足、3…どちらともいえない、2…やや不満、1…とても不満、0…該当なし)・その他
Are you satisfied with the Center overall? 
Please write down if there is anything you noticed. 
Optional: The information given here will be used only for the improvement of our service.
Hospital ID Card Number 
Please input 8-digit hospital ID card number.
In the case of 45-years-old, input 45.