Enrollee Feedback

Enrollee Feedback
Company *
Feedback period
Please rate from 1 to 5 on the mentioned survey parameters.

* Poor = 1, Fair = 2, Acceptable = 3, Optimum = 4, Excellent = 5

Please select the number, which most accurately reflects your satisfaction level

1. How are you satisfied with the quality of care/services you received at the hospital whenever you visit? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

2. How prompt does Alleanza HMO respond to your request/complaint through the call centre *

	1	2	3	4	5

1 is Poor, 5 is Excellent

3. Did you find registering on our HMO easy and seamless? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

4a. Were you attended to on time at the hospital. *

YES NO
4b. kindly indicate Hospital visited (optional):
4c. How long does it take before you were attended to by the doctor kindly tick. *

0 - 30 Mins 30 Mins - 2 Hrs 2 Hrs - 6 Hrs 6 Hrs - 12 Hrs Above 12 Hrs

5. To what extent did we meet your expectations in terms of access to hospital and quality of care, customer service etc? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

6. To what extent did Alleanza HMO satisfy you when you requested/ complained of an issue/ service. *

	1	2	3	4	5

1 is Poor, 5 is Excellent