{% extends "layouts/public_base.html" %} {% load i18n static %} {% block title %}{% trans "Submit Feedback" %} - PX360{% endblock %} {% block extra_css %} {% endblock %} {% block content %}
{% get_available_languages as LANGUAGES %} {% get_current_language as LANGUAGE_CODE %} {% for lang_code, lang_name in LANGUAGES %} {% if lang_code == 'en' %}πŸ‡¬πŸ‡§{% elif lang_code == 'ar' %}πŸ‡ΈπŸ‡¦{% endif %} {{ lang_name }} {% endfor %}
Al Hammadi Hospital

{% trans "We Value Your Feedback" %}

{% trans "Your feedback helps us improve our services and provide better care for everyone. Choose a category below to get started." %}

{% trans "Complaint" %}

{% trans "Report an issue with our services. We take all concerns seriously and will investigate thoroughly." %}

{% trans "Observation" %}

{% trans "Help us improve safety by sharing what you've noticed. Anonymous submissions are welcome." %}

{% trans "Inquiry" %}

{% trans "Have questions? We're here to help with appointments, services, or general information." %}

{% trans "Appreciation" %}

{% trans "Recognize a staff member or team who made a positive difference in your experience." %}

{% trans "Suggestion" %}

{% trans "Share your ideas to help us improve our services and facilities for everyone." %}

{% trans "Already submitted something?" %}

{% trans "Track Your Submission" %}
{% endblock %} {% block extra_js %} {% trans "Error" as t_error %} {% trans "Failed to load form." as t_failed_to_load_form %} {% trans "Select Category" as t_select_category %} {% trans "optional" as t_optional %} {% trans "Report an Observation" as t_report_an_observation %} {% trans "Help us improve by reporting issues you notice. Your input is valuable." as t_help_us_improve_by_reporting_issues_you_notice_you %} {% trans "Category" as t_category %} {% trans "Severity" as t_severity %} {% trans "Low" as t_low %} {% trans "Medium" as t_medium %} {% trans "High" as t_high %} {% trans "Critical" as t_critical %} {% trans "Title" as t_title %} {% trans "Brief descriptive title" as t_brief_descriptive_title %} {% trans "Description" as t_description %} {% trans "Describe what you observed in detail..." as t_describe_what_you_observed_in_detail %} {% trans "Location" as t_location %} {% trans "Where did this occur?" as t_where_did_this_occur %} {% trans "When" as t_when %} {% trans "Attachments" as t_attachments %} {% trans "Click to upload files" as t_click_to_upload_files %} {% trans "Images, PDF, Word (max 10MB)" as t_images_pdf_word_max_10mb %} {% trans "Your Info" as t_your_info %} {% trans "optional - leave blank for anonymous" as t_optional_leave_blank_for_anonymous %} {% trans "Staff ID" as t_staff_id %} {% trans "Name" as t_name %} {% trans "Phone" as t_phone %} {% trans "Email" as t_email %} {% trans "Submit Observation" as t_submit_observation %} {% trans "Submitting..." as t_submitting %} {% trans "Failed to submit" as t_failed_to_submit %} {% trans "Select Hospital" as t_select_hospital %} {% trans "Inquiry Details" as t_inquiry_details %} {% trans "Your full name" as t_your_full_name %} {% trans "Email Address" as t_email_address %} {% trans "Phone Number" as t_phone_number %} {% trans "Your phone number" as t_your_phone_number %} {% trans "Hospital" as t_hospital %} {% trans "General Inquiry" as t_general_inquiry %} {% trans "Services Information" as t_services_information %} {% trans "Appointments" as t_appointments %} {% trans "Billing & Insurance" as t_billing_insurance %} {% trans "Medical Records" as t_medical_records %} {% trans "Other" as t_other %} {% trans "Subject" as t_subject %} {% trans "Brief subject of your inquiry" as t_brief_subject_of_your_inquiry %} {% trans "Message" as t_message %} {% trans "Please describe your inquiry in detail..." as t_please_describe_your_inquiry_in_detail %} {% trans "Submit Inquiry" as t_submit_inquiry %} {% trans "Failed" as t_failed %} {% trans "Select Location" as t_select_location %} {% trans "Main Section" as t_main_section %} {% trans "Subsection" as t_subsection %} {% trans "Select Main Section" as t_select_main_section %} {% trans "Select Subsection" as t_select_subsection %} {% trans "Select Domain" as t_select_domain %} {% trans "Select Subcategory" as t_select_subcategory %} {% trans "Select Classification" as t_select_classification %} {% trans "Failed to submit. Please try again." as t_failed_to_submit_please_try_again %} {% trans "Share Your Appreciation" as t_share_your_appreciation %} {% trans "Recognize a staff member or team who made a difference in your experience." as t_recognize_a_staff_member_or_team_who_made_a_differ %} {% trans "Your Name" as t_your_name %} {% trans "Your Phone" as t_your_phone %} {% trans "Staff / Department Name" as t_staff_department_name %} {% trans "Name of staff or department" as t_name_of_staff_or_department %} {% trans "Your Appreciation" as t_your_appreciation %} {% trans "Share what this person or team did that made your experience special..." as t_share_what_this_person_or_team_did_that_made_your_ %} {% trans "Submit Appreciation" as t_submit_appreciation %} {% trans "Thank You!" as t_thank_you %} {% trans "Thank you for your appreciation! Your kind words will be reviewed and shared with the staff member or department you recognized." as t_thank_you_for_your_appreciation_your_kind_words_wi %} {% trans "Share Your Suggestion" as t_share_your_suggestion %} {% trans "Your ideas help us improve. Share how we can make our services better for everyone." as t_your_ideas_help_us_improve_share_how_we_can_make_o %} {% trans "Suggestion Area" as t_suggestion_area %} {% trans "General" as t_general %} {% trans "Clinical Care" as t_clinical_care %} {% trans "Facility & Environment" as t_facility_environment %} {% trans "Staff Service" as t_staff_service %} {% trans "Communication" as t_communication %} {% trans "Technology & Systems" as t_technology_systems %} {% trans "Food Service" as t_food_service %} {% trans "Appointment & Scheduling" as t_appointment_scheduling %} {% trans "Suggestion Title" as t_suggestion_title %} {% trans "Brief title for your suggestion" as t_brief_title_for_your_suggestion %} {% trans "Your Suggestion" as t_your_suggestion %} {% trans "Describe your suggestion in detail. What would you like to see improved or changed?" as t_describe_your_suggestion_in_detail_what_would_you_ %} {% trans "Submit Suggestion" as t_submit_suggestion %} {% trans "Thank you for your suggestion! We appreciate your input and will review it carefully." as t_thank_you_for_your_suggestion_we_appreciate_your_i %} {% trans "Failed to load hospitals." as t_failed_to_load_hospitals %} {% trans "Ask a question. We'll respond within 24-48 hours." as t_ask_a_question_we_ll_respond_within_24_48_hours %} {% endblock %}