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Questionnaire for complaints and suggestions


Kayan Medical Center always welcomes suggestions, comments and complaints from all customers, so please fill out the form accurately and credibly.

We will handle complaints with the utmost confidentiality.

Determine what is required *

Patient Name *

Relationship

Mobile Number *

Sex *

Branch *

Concerned Section *

Visit Date

Name of attending physician, nurse or staff member

Description of the problem or suggestion *

As a result of your complaint, what would you like to see happen?