1		Name	:
	2		Age	:	Below 20 year	40-50 year
					20-30 year	Above 50 year
					30-40 year
	3		Sex	:	Male	Female
	4		E-Mail	:
	5		Educational qualification	:	Undergraduate	Diploma
					Postgraduate	Professional degree
					Others
	6		Occupation	:	Student	Professional
					Self-employed	Others
	7		How did you come to know of the Tinplate Hospital website?
					Newspaper	Friends / relatives
					Hoarding	Brochures
					Others
	8		What other information/services would you like to be made available on the site?
	9		Kindly read the following statements and choose whichever is appropriate
			Note: A*: Extremely satisfied ;              B*: Satisfied ;              C*: Neither satisfied nor dissatisfied ;              D*: Dissatisfied ;              E*: Extremely dissatisfied .
	A* B* C* D* E* a. Content on the site b. Navigation through the site c. List of doctors available on the site d. List of medical specialties available e. Health news/articles available on the website f. Feed back/follow up by the hospital after receiving your queries g. Speed with which the pages download h. Graphical appeal of the website
	10		Does your organization have a corporate tie up with Tinplate Hospital?
					Yes	No