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Nama :................................................................................................. Form Kritik Dan Saran

Umur :................................................................................................. Nama :.................................................................................................
Jenis Kelamin :................................................................................................. Umur :.................................................................................................
Kritik dan Saran :................................................................................................. Jenis Kelamin :.................................................................................................
.................................................................................................................................................. Kritik dan Saran :.................................................................................................
.................................................................................................................................................. ..................................................................................................................................................
............................................................................................................................................... ..................................................................................................................................................
Bagaimana pendapat anda terhadap pelayanan Puskesmas Detusoko: ...............................................................................................................................................
Puas Tidak puas Bagaimana pendapat anda terhadap pelayanan Puskesmas Detusoko:
Berilah tanda (√) pada kolom diatas. Puas Tidak puas
Mohon untuk menuliskan identitas, Kami menjamin kerahasiaan identitas Berilah tanda (√) pada kolom diatas.
penulis. Mohon untuk menuliskan identitas, Kami menjamin kerahasiaan identitas
penulis.

Nama :.................................................................................................
Umur :.................................................................................................
Kritik dan Saran :.................................................................................................
Jenis Kelamin :.................................................................................................
..................................................................................................................................................
Kritik dan Saran :.................................................................................................
..................................................................................................................................................
..................................................................................................................................................
...............................................................................................................................................
..................................................................................................................................................
Bagaimana pendapat anda terhadap pelayanan Puskesmas Detusoko:
...............................................................................................................................................
Puas Tidak puas
Bagaimana pendapat anda terhadap pelayanan Puskesmas Detusoko:
Berilah tanda (√) pada kolom diatas.
Mohon untuk menuliskan identitas, Kami menjamin kerahasiaan identitas
Puas Tidak puas
penulis. Berilah tanda (√) pada kolom diatas.
Mohon untuk menuliskan identitas, Kami menjamin kerahasiaan identitas
penulis.