IIRC Patient Satisfaction Survey

Your Name *
Your Email ID *
Your Partner's Name *
Your serial number with IIRC
Month/year of visit
1. Please select the IIRC doctors who saw you:
Dr Mamata Deenadayal Dr. Surabhi Suresh Dr. Sapna Srinivas Dr. Aarthi Deenadayal Tolani
Dr. Sadashivan Dr. Bharathi Dr.Rekha Rubin Dr. Kadambari
If Others: Specify name
2. Please comment on their approach to your case.
Excellent Good Average Poor
Comment
3. Please rate your doctor�s responsiveness to your needs/ questions/ concerns during your treatment.
Excellent Good Average Poor
Comment
4. Please indicate how well costs, billing and other financial issues were addressed by the billing
    department at IIRC.
Excellent Good Average Poor
Comment
5. Please rate the overall helpfulness and competence of the front desk staff at IIRC.
Excellent Good Average Poor
Comment
6. Please rate the overall level of care you received at IIRC.
Excellent Good Average Poor
Comment
7. How did you initially find/ hear about IIRC?
 
8. Why did you choose IIRC for your treatment? (Please check all that apply)
Reputation Doctor's Reputation Location Costs
Recommended by someone you know Recommended by your Doctor
Name of the doctor/person who recommended us
9. Please provide any suggestions you have that would make your future experiences at IIRC better.
 

Feedback Form for IVF/ICSI

Your Name
Your Email ID
Your Partner's Name
Your serial number with IIRC
Month/year of IVF/ ICSI
1. Did you have any problems at the reception?
Yes No
2. Have the staff been cordial/ helpful to you?
Yes No
3. Have you been counseled adequately regarding your case and process of IVF/ICSI by our doctors?
Yes No
4. Have you been told about the pregnancy rate in your case? Have you clearly understood that a guarantee to pregnancy cannot be given?
Yes No
5. Name of doctor/s who counselled you during the course of treatment?
Dr Mamata Deenadayal Dr. Surabhi Suresh Dr. Sapna Srinivas
Dr. Aarthi Deenadayal Tolani Dr. Sadashivan
Comment
6. How were the Research assistants with you?
 
7. Were you handled well by our nursing staff?
Yes No
 
8. Have you been told about the possible complications associated with this procedure
Yes No
9. Have your drugs/medication been explained to you by one of the doctors?
Yes No
10. Were you explained about cost factor and that this amount is non reimbursable, whether the cycle fails or succeeds?
Yes No
11. Did you have any problem with the accounts department/ billing room?
Yes No
12. Have your oocyte/ embryo details been explained to you by our embryologist/doctors?
Yes No
13. Do you have any suggestions/ Comments