Doctors Questionnaires
Step
1
of 11
9
%
Hospital Name
Hospital Location
How many years of practice experience do you have?
*
1-3 years
3-5 years
5-10 years
10+ years
Ownership status of the clinic/ hospital?
*
Rented
Self owned
For how many years have practice experience to you have?
*
0
1
2
3
How many cataract surgeries happened at the clinic/hospital in a year?
*
100-500
500+
Which of the following procedures can you perform?
*
Cataract
Vitrectomy
Squint
Lasik
ICL
C3R
The total number of staff members in the clinic or hospital?
Doctor
*
1
2
3
4
4
Optometrist
*
1
2
3
4
4
Reception
*
1
2
3
4
4
Admin
*
1
2
3
4
4
Others
*
1
2
3
4
4
Which key TPA / Panels does the hospital clinic have?
*
0 of 500 max characters
Please ticks the certifications that you have?
*
QCI
NABH
BMW
Fire NOC
What are the key reasons why you want to partner with EyeMantra?(Tick all that apply)
*
TPA/ Empanelments
Online marketing
Offline / Field marketing
Center management
Admin / Accounts
Business expansion
Confirm your details
Name
*
Email
*
Mobile Number
*
Address
*
0 of 500 max characters
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