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Questionnaire form

▼Information of respondent
Tell it about a visitor if all right.
Sex
Age
Area to live
▼Impression when it was done the next House
How was the atmosphere of our House?
The correspondence of the reception desk?
How long did it take for waiting?
About correspondence of the nursing staff
About the medical examination of the doctor
▼About facilities facilities
General impression
In-hospital guidance indication
▼About our site
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Medical corporation Fukuji fortune surgery hospital
〒641-0021
Wakaurahigashi, Wakayama-shi, Wakayama
3-5-31
TEL. 073-445-3101
FAX. 073-445-4660
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