Patient Feedback

1. Patient Information

Name (optional):

Nationality:

Date of Visit:

Type of Treatment:

Hospital/Clinic Visited:

2. Services Evaluation

Please rate the following on a scale of 1 to 5:
(1 = Poor, 5 = Excellent)

Service Area	1	2	3	4	5
Initial Response & Communication
Visa/Travel Assistance
Airport Pickup & Transport
Hospital/Doctor Coordination
Treatment Quality
Accommodation Arrangement
Overall Experience with MedAsk Tours

3. Feedback

What did you like the most about our service?

Any suggestions for improvement?

Would you recommend MedAsk Tours to others?
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Patient Signature:

Date:

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