Visitor satisfaction questionnaire template

Dear Sir or Madam,

By filling out this survey, you help us improve visitor/patient experience and increase quality of provided services.

We truly appreciate your insight and your time.

Important: This survey is completely anonymous.

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

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

2. When was your last visit to [name of your medical facility]?

Select one answer

  • Today
  • Few days ago
  • Few weeks ago
  • More than one month ago

3. Which unit did you visit?

Select one answer

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

4. How would you rate the individual aspects of the facility?

Select one answer in each row

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Cleanliness

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Comfort

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Privacy

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Safety

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Room amenities

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Food services

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

5. How would you rate the communication with the attending physician?

  • -2
  • -1
  • 0
  • 1
  • 2

Confusing

Clear

  • -2
  • -1
  • 0
  • 1
  • 2

Dishonest

Honest

  • -2
  • -1
  • 0
  • 1
  • 2

Indifferent

Compassionate

  • -2
  • -1
  • 0
  • 1
  • 2

Vague

Detailed

  • -2
  • -1
  • 0
  • 1
  • 2

Disrespectful

Respectful

  • -2
  • -1
  • 0
  • 1
  • 2

Alarming

Reassuring

  • -2
  • -1
  • 0
  • 1
  • 2

One-sided

Interactive

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

Select one answer

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

7. 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 facility creates a welcoming and calm environment.

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

The facility's infrastructure ensures easy accessibility and hassle-free parking.

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

The facility uses state-of-the-art medical equipment.

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

The facility canteen offers a wide selection of food and beverages.

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

Waiting rooms and public areas offer a sufficient amount of seating and space.

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

Visiting hours at this facility suit my needs well.

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

The facility's information system provides clear and useful information.

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

8. How easy was it for you to find your way around the facility?

Select one answer

  • Choose...
    • Choose...
    • Very easy
    • Rather easy
    • Rather difficult
    • Very difficult

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

🙋🏽‍♂️ Visitor satisfaction survey 🙋🏽‍♀️

Popularity 5 ×

Gain insightful feedback with our visitor satisfaction questionnaire template, tapping into the unique perspectives of visitors coming to see patients in your institution.

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The survey sample is ideal for

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

Our visitor satisfaction questionnaire template is specifically designed to capture the often-overlooked feedback, which can still provide valuable insights into their experiences with your facility. Using this tailored questionnaire will aid in identifying strengths and areas for improvement, ensuring a welcoming and positive environment for everyone who comes through your doors.

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

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