QUALITY ASSURANCE - CLIENT QUESTIONNAIRE FORM
  We would like to know how well we and our providers are serving you and what you would prefer
  we improve on. Could you therefore complete this questionnaire?.
1. How long have you been on THT Health Scheme?
  1 - 3 Months
  6 Months
  9 Months		   12 Months
  Over 12 Months
2. Indicate Your Health Plan 
  Standard
  Silver Plus
  Gold		   Platinum
  Platinum Plus
  NHIS
3. Have you used the THT Healthcare Scheme? 
  Yes, Personally
  No, but my colleague has		   No, my dependants have
  Not applicable
4. How would you rate the service you received from your selected THT Provider Hospital with respect to friendliness and courtesy?
  Excellent
  Very Good
  Good		   Average
  Poor
  Not Applicable
5. How would you rate the attitude of the Nurses towards your complaints/request at your THT Provider Hospital?
  Very Friendly
  Friendly
  Unfriendly		   Rude
  Indifferent
  Not Applicable
6. How would you rate the response time of your selected Provider Hospital to your medical needs?
  Very Prompt
  Prompt
  Rather Slow		   Slow
  Not Applicable
 
7. What is the condition of the Hospital facilities?
  Very Good
  Fair
  Good		   Poor
  Very Poor
 
8. Have you read your membership Handbook?
  Yes     No     Not Applicable  
9. Have you used the helpline facility indicated on the handbook at any time?
  Yes     No     Not Applicable  
10. Were you satisfied with the response from the helpline?
  Yes     No     Not Applicable  
11. Would you recommend THT as a HMO to your friends?
  Yes     No     Not Applicable  
12. Comments
13. Your comments are most welcomed and will be treated with discretion and privacy, however, if you want to share this comment with your provider please indicate below.
  Yes     No  
14. Email:
 
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