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Hospital Patient Survey

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"?
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2 How many days were you in the hospital?
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3 How did you select "hospital"?
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4 What is the specialty of the doctor who admitted you to this hospital?
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5 What type of unit were you in for most of your stay?
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6 Rate the following statements concerning "hospital":
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Strongly agree
Strongly disagree
Highest quality doctor staff in the area
Highest quality nursing staff in the area
Most up-to-date medical equipment
Most up-to-date facilities in the area
My doctors were skilled and experienced
My doctor was kind and caring
My doctor kept me fully informed
Tests and procedures were completely explained to me
The nurses were skilled in the treatment provided me
The nurses were responsive when I called

7 What is your overall satisfaction with [HOSPITAL] and the medical care you received?
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8 Please comment on your experience as a patient of "hospital":

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