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* 1. Please enter your Name and Surname.

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* 2. Please enter the name of your Ward.

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* 3. Please enter your Admission Number (if available).

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* 4. Please rate the Admin at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 5. Please rate the Medication, Drip/IV Line and Pain Management at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 6. Please rate the Nursing Care and Communication Skills of Nurses at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 7. Please rate the Response Time of Nurses when you call/buzz for them with your Nurse-Call buzzer, at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 8. Please rate the cleanliness and neatness of Buildings, Rooms and Wards at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 9. Please rate the Catering Service at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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* 10. Please rate your Overall Experience at Midlands Medical Centre on a scale of 0 to 10.

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
b

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