Medical staff evaluation questionnaire template

Dear Sir or Madam,

By filling out this survey, you help us increase the quality of provided healthcare services.

We truly appreciate your insight and your time.

Important: This survey is completely anonymous.

1. What was the reason for your visit?

Select one answer

  • Medical treatment
  • Visiting another patient

2. Which unit were you admitted to, if hospitalized / Which unit did you visit, if visiting a patient?

Select one answer

  • [Unit 1]
  • [Unit 2]
  • [Unit 3]

3. What is your overall satisfaction with [name of your medical facility]?

(1 star = minimum satisfaction / 5 stars = maximum satisfaction)

4. How much do you agree with the following statements?

Select one answer in each row

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff is skilled and experienced.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff is kind and caring.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff always responds to my requests and concerns.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff clearly communicates information about the treatment.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff works as a team, demonstrating coordination and professionalism.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff respects patient privacy and confidentiality.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The medical staff creates a safe and trusting environment.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

5. How would you assess the atmosphere in the [healthcare unit]?

Indicate which value you incline to

  • -2
  • -1
  • 0
  • 1
  • 2

Unwelcoming

Welcoming

  • -2
  • -1
  • 0
  • 1
  • 2

Unfriendly

Friendly

  • -2
  • -1
  • 0
  • 1
  • 2

Stressful

Comfortable

  • -2
  • -1
  • 0
  • 1
  • 2

Chaotic

Easy-going

  • -2
  • -1
  • 0
  • 1
  • 2

Indifferent

Supportive

  • -2
  • -1
  • 0
  • 1
  • 2

Detached

Empathetic

6. Have you ever received conflicting information from different medical staff members?

Select one answer

  • No, I have always received consistent information.
  • Yes, but it was a rather rare experience.
  • Yes, this happened on multiple occasions.

7. Based on your observation/experience, how well did the medical staff handle emergencies/urgent situations?

Select one answer

  • Extremely well
  • Very well
  • Well
  • Slightly well
  • Not at all well
  • Can't tell

8. Are there any staff members you would like to particularly mention?

Please provide more context as to the reasons why.

500

9. How likely are you to recommend [name of your medical facility] to your friends and relatives?

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Not at all likely

Extremely likely

10. Do you have any other suggestions for improving our services?

500

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Survey Templates Healthcare

👨🏻‍⚕️ Medical staff evaluation survey 👩🏻‍⚕️

Popularity 12 ×

Use the medical staff evaluation questionnaire template to collect valuable feedback and improve healthcare quality. Increase staff engagement and their effectiveness.

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The survey sample is ideal for

  • managers of hospital departments,
  • senior management,
  • directors of private medical centers and clinics.

Improve your medical staff's performance by gathering feedback from patients and their visitors. Discover perceptions of your team's communication skills, teamwork, and overall behavior. Identify opportunities for potential improvements and tailor the survey with your specific questions to address unique challenges. Efficiently use the data to continuously build your institution's reputation.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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