Hospital satisfaction questionnaire template

Dear Sir / Madam,

thank you for visiting us. By filling out this 5-10 minute survey, you will help us obtain the very best results.

1. Was this your first time as a patient at "hospital"?

2. How many days were you in the hospital?

  • 1-3 days
  • 4-6 days
  • 7+

3. How did you select "hospital"?

  • My doctor recommended
  • It was my own choice
  • I came through emergency dept

4. What is the specialty of the doctor who admitted you to this hospital?

  • General / Internal
  • Pediatrician
  • Gynecologist
  • Ear, Nose, Throat
  • General Surgery
  • Neurosurgery
  • Urology
  • Orthopedic
  • Cancer / Tumor

5. What type of unit were you in for most of your stay?

  • Maternity
  • General
  • Surgical
  • Intensive
  • Rehabilitation
  • Pediatric
  • Children's

6. Rate the following statements concerning "hospital":

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Highest quality doctor staff in the area

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Highest quality nursing staff in the area

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Most up-to-date medical equipment

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Most up-to-date facilities in the area

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

My doctors were skilled and experienced

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

My doctor was kind and caring

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

My doctor kept me fully informed

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Tests and procedures were completely explained to me

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

The nurses were skilled in the treatment provided me

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

The nurses were responsive when I called

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

7. What is your overall satisfaction with [HOSPITAL] and the medical care you received?

8. Please comment on your experience as a patient of "hospital":

500

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Hospital Patient Survey

Popularity 621 ×

Strive to improve patient care. Want their feedback. You will get an objective assessment from the hospital satisfaction questionnaire template.

Use template — it’s free

The survey sample is ideal for

  • hospital management.

Become a widely recognized hospital that is the most sought after. Use the data obtained from the answers to the hospital satisfaction questionnaire and focus on the most frequently mentioned areas. Patients usually evaluate the personnel composition of given department and the approach of individual members, material provision, quality of food, waiting time for specific examinations or administrative processes. Add questions to topics that are relevant to you in the survey sample.

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

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