Al-Shifa Trust Eye Hospital
Survey Form
Name
*
Cell/Phone
*
(Please Provide Country Code)
Email
*
Please read the questions carefully and select your answer from the drop down list given in front of each.
Q-1
Do you receive our quarterly Newsletter?
Yes
No
Not Regularly
Q-2
Do you visit our website?
Yes
No
Q-3
How long have you been associated with Al-Shifa?
One Year
Two Years
Three Years and more
Q-4
From where did you get information before associating with Al-Shifa?
Television
Al-Shifa Website
Newspaper
Friends/Family
Other
Q-5
What has been the motivating factor for donation to Al-Shifa?
Mission of Al Shifa Trust
Treatment facilities available
Trust in the system of Al Shifa
Others (Mention if any)
Q-6
Any suggestions for improvements at Al-Shifa