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Patient and Family Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
1

How would you rate the overall care provided to the patient?

Please select one option.
2

On a scale of 1 to 10, how would you rate your satisfaction with the communication from healthcare providers?

Please rate from 1 to 10, where 1 is very dissatisfied and 10 is very satisfied.
3

Please share any additional comments or feedback about the patient's care:

Please type your response in the space provided.
4

Did the patient receive timely treatment and attention?

Please select one option.
5

Were the family members involved in the patient's care decision-making process?

Please select one option.
6

How likely are you to recommend this healthcare facility to others?

Please rate your likelihood on a scale of 1 to 10.
7

Please share any suggestions for improvement in the patient care experience:

Please type your response in the space provided.
8

Were the family members satisfied with the level of information provided about the patient's condition?

Please select one option.
9

How would you rate the emotional support provided to both the patient and the family members?

Please select one option.
10

In your opinion, how could the healthcare facility better support the patient's family members?

Please type your response in the space provided.