Please let us know your opinion(Inpatient)

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 stay here.
Please note that all fields followed by an asterisk must be filled in.

5:Very satisfied, 4:Satisfied, 3:Neither satisfied, 2:Dissatisfied, 1:Very dissatisfied, 0:Non of them
 
Medical Information
Questionnaire No. 
Please input without hyphens
In the case of 0228-001, input 0228001
Department 
Ward 
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 
Facility
Easy to understand signs 
Medical equipment 
Toilet/sink area 
Shared space 
Shop 
Coffee shop 
Restaurant 
Parking lot 
Environment / Services
Easy to understand documents and explanation at the time of admittance 
Selection of rental products and prices 
Meals 
Safety measures 
Hygiene/Cleanliness 
Bed/bedclothes 
Air-conditioning/ventilation 
Privacy protection measures 
Assistance for obtaining information 
Good communication and cooperation among staff 
Treatment
Did you receive sufficient explanation from the doctors about the diagnosis and treatment plan of yo 
Ease of consulting and asking questions to the doctors 
Explanation and manners of the nurses and midwives 
Ease of asking quesitons to the nurses and midwives 
Were you happy with the doctors? 
Were you happy with the nurses and midwives? 
Hospitality(Wording and manners)
Doctors 
Nurses/Midwives 
X-ray technologists 
Laboraory technologists 
Registered nutritionists 
Pharmacists 
Admission receptionists 
Nursing assistants (Ward clerks/Nurse assistants) 
Medical fee billing staff 
Rehabilitation staff 
Comprehensive evaluation
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.
Name 
Hospital ID Card Number 
--
Please input 8-digit hospital ID card number.
Age 
In the case of 45-years-old, input 45.