Dear respondent:

We are students from IBA, Dhaka University doing a survey on service quality of Bangladesh Eye
Hospital. We need some of your time to help us complete this survey which would help the hospital
to provide quality service for you. This information is only for academic purposes and will not be
disclosed elsewhere.
Gender:

Age:

Occupation:

Relation with the Patient:

You are a 1) Regular, 2) Occasional, 3) First Time patient in this hospital

Quality Aspects

Tangibility

No. Questions
1.
The hospital has modern and up-to-date
equipment
2.
The hospitals physical facilities are pleasant and
appealing
3.
The hospitals physical facilities are neat and clean

1=Lowest; 7=Highest
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4.

The hospital staff have professional outfits

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5.

The hospital staffs have neat appearances

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6.

The reports and other documents delivered to the 1 2 3 4 5 6 7

patients are visibly appealing and easily
understood
The hospital conducts its activities on time
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7.
8.
Reliability

9.
10.
11.
12.
13.

Responsiveness
14.
15.
16.
17.
Assurance
18.

The hospital shows sincerity in solving the

problems of the patient
The hospital performs the services and procedures
right the first time
The hospital provides the services within the
promised time regarding the service delivery
The hospital provides error free reports
documents and information
The staff keep the patients informed about exactly
when the services will be performed
The patients can expect prompt services from the
hospital employees
The hospital staff are always willing to help the
patients
The staff are all time available to respond to
patients requests
The patients feel safe in their interaction with the
hospital employees as the employees are polite
The behavior of the staff are reassuring to the
patients
The patients feel secure in using the hospitals
services

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Assurance

19.
20.
21.

Empathy

22.
23.
24.

The hospital staff are adequately knowledgeable 1 2 3 4 5 6 7

to answer any question from the patients
The staff pay individual attentions to each patient 1 2 3 4 5 6 7
The hospital operates at times suitable to the
patients
The hospital prioritizes the interests of the
patients
The staff understands the specific need of the
patients
The hospital has the patients best interest at
heart

Thank You for your Time

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