Name

Address

Telephone

Email Address

What suggestions do
you have for us to improve our facilities
and services?

What do you like about
our services and staff?

Would you like to join
our Patient Focus Group?

Yes
No

Would you like us
to acknowledge your
feedback?

Yes (please provide your telephone number)
No

How did you get to
know about NUH?

Through friends/relatives
Through GP/Family Dr
Newspapers
TV / Radio
Magazines
Internet
Others