Anda di halaman 1dari 79

FORMULIR PENGISIAN KRITIK DAN SARAN

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..........................................................................

NAMA

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Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
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FORMULIR PENGISIAN KRITIK DAN SARAN

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NAMA

Alamat

No . Telp/HP

Tanggal

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2. Saran :
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1. Kritik
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Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

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2. Saran :
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Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

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..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

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2. Saran :
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1. Kritik
:
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2. Saran :
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..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

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2. Saran :
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1. Kritik
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2. Saran :
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2. Saran :
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..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan

1. Kritik
:
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2. Saran :
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2. Saran :
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..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................
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..........................................................................
..........................................................................
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2. Saran :
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2. Saran :
...................................................................

..............................................................
Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..........................................................................

Alamat

No . Telp/HP

Tanggal

..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

1. Kritik
:
...................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal
1. Kritik

:
:

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..........................................................................

NAMA

..........................................................................

Alamat

..........................................................................

No . Telp/HP

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Tanggal

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2. Saran :
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..............................................................

1. Kritik
:
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..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :

1. Kritik
:
...................................................................
..........................................................................

..........................................................................

Alamat

..........................................................................

No . Telp/HP

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Tanggal

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2. Saran :
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1. Kritik
:
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..........................................................................
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..........................................................................
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2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

1. Kritik
:
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..........................................................................

Tanggal

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2. Saran :
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1. Kritik
:
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..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
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2. Saran :
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1. Kritik
:
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..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

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..........................................................................

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2. Saran :
...................................................................

..........................................................................

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

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..........................................................................

..........................................................................

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2. Saran :

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..........................................................................

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2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
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..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..............................................................
Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..........................................................................

Alamat

No . Telp/HP

Tanggal

..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

1. Kritik
:
...................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal
1. Kritik

:
:

...................................................................
..........................................................................

NAMA

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
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..............................................................

1. Kritik
:
...................................................................
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..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :

1. Kritik
:
...................................................................
..........................................................................

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

...................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

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2. Saran :

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..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..............................................................
Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..........................................................................

Alamat

No . Telp/HP

Tanggal

..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

1. Kritik
:
...................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal
1. Kritik

:
:

...................................................................
..........................................................................

NAMA

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :

1. Kritik
:
...................................................................
..........................................................................

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

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...................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

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2. Saran :

...................................................................

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..........................................................................

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..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
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..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..............................................................
Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..........................................................................

Alamat

No . Telp/HP

Tanggal

..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

1. Kritik
:
...................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal
1. Kritik

:
:

...................................................................
..........................................................................

NAMA

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :

1. Kritik
:
...................................................................
..........................................................................

..........................................................................

Alamat

..........................................................................

No . Telp/HP

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..............................................................

NAMA

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

...................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :

...................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
NAMA

Alamat

Mohon mengisi formulir di atas dan

No . Telp/HP

masukkan ke kotak saran, demi peningkatan

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

pelayanan Rumah Sakit Royal Prima Jambi.


Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
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2. Saran :
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..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..........................................................................
..............................................................

..........................................................................

Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..............................................................

Alamat

No . Telp/HP

Tanggal

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN


NAMA

Alamat

No . Telp/HP

Tanggal

..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.

1. Kritik
:
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

..........................................................................

..........................................................................

..........................................................................

.............................................................
2. Saran :
...................................................................

..............................................................
Mohon mengisi formulir di atas dan

..........................................................................

masukkan ke kotak saran, demi peningkatan

..........................................................................

pelayanan Rumah Sakit Royal Prima Jambi.

..........................................................................

Terima Kasih.

..........................................................................

FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................

NAMA

..........................................................................

Alamat

No . Telp/HP

Tanggal

..............................................................
Mohon mengisi formulir di atas dan
masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.

1. Kritik
:
...................................................................
..........................................................................

Terima Kasih.
FORMULIR PENGISIAN KRITIK DAN SARAN

..........................................................................
..........................................................................
..........................................................................
..........................................................................
..........................................................................

NAMA

Alamat

No . Telp/HP

Tanggal
1. Kritik

:
:

...................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..........................................................................

..............................................................

..........................................................................
.............................................................
2. Saran :
...................................................................
..........................................................................

Mohon mengisi formulir di atas dan


masukkan ke kotak saran, demi peningkatan
pelayanan Rumah Sakit Royal Prima Jambi.
Terima Kasih.