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ONLINE FEEDBACK FORM
Applicant
Are you the Patient?
Are you the Donor?
Are you a family member?
Other
Title
Mr.
Mrs.
Miss.
Ms.
Name
CNIC
Cell Number
Patient
Donor
Relationship
Date of Transplant
Transplant Type
Select
Liver Transplant
Kidney Transplant
Bone Marrow
Cornea
Hospital
Select
Pakistan Institute of Medical Sciences (PIMS), Islamabad.
KRL Hospital, Islamabad.
Pakistan Atomic Energy Commission (PAEC) Islamabad.
Army Liver Transplant Unit Military hospital, MH – Rawalpindi.
Armed Forces Institute of Urology (AFIU), Rawalpindi.
Armed Forces Institute of Cardiology (AFIC), Rawalpindi.
Armed Forces Bone Marrow Transplant Centre (AFBM TC), Rawalpindi.
Armed Forces Institute of Opthalmology (AFIO) Rawalpindi
Shiekh Khalifa Bin Zayed Al Nahyan Hospital, Muzaffarabad, AJK
Divisional Headquarter Teaching Hospital, Mirpur AJK.
Shifa International Hospital, Islamabad.
Max Health Hospital, Islamabad.
Akbar Khan Niazi Teaching Hospital, Islamabad
Maroof International Hospital, Islamabad.
Shafi International Hospital, Islamabad.
Quaid-e-Azam International Hospital, Islamabad.
Ali Medical Hospital, Islamabad.
Kulsoom International Hospital, Islamabad
Rawal Institute of Health Sciences, Islamabad
Life Care International Hospital, Islamabad
How was your experience of Organ Transplant (Liver/Kidney/Cornea/Bone Marrow) in the center of your choice?
Are you Happy with the overall transpant & general care services of your respective Transplant center?
Do you think that the cost of the treatment is worth for the service provided. Are you happy with the fee structure?
What so you suggest to improve the quality of services offered by the transplant center?
Have your Transplant center introduced HOTA to you before the selection of donor, explaining you the donor criteria approved by HOTA?
Any difficulties/complaints regarding your stay in the Hospital?
What is the outcome of your Transplant regarding mobidity or mortality of your patient?
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Undertaking
I hereby confirm that the information provided herein is accurate, correct and complete and that the documents submitted along with this application form are genuine.
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