survey examples Business & Marketing

Patient Satisfaction Survey

  • Patient Satisfaction Survey

    We would be very appreciative if you could spare a few minutes to give us feedback about the care you received.
     
  • 1. What is your first name? *

  • 2. What's your gender?

    You can give only one answer.
  • 3. What is your last name? *

  • 4. How old are you?

    You can give only one answer.
  • 5. Were you a new or returning patient? *

    You can give only one answer.
  • 6. When were you admitted? *

    Please, pick a date.
    y
  • 7. And what was the reason for your visit?

    You can give only one answer.
  • [ANS_1], please tell us to what extent you agree or disagree with each of the following statements.

    Your ratings will be treated with the utmost confidence.

  • 8. It was easy to make my appointment. *

    You can give only one answer.
  • 9. Appointments were available within a reasonable amount of time. *

    You can give only one answer.
  • 10. Checking in was fast and efficient. *

    You can give only one answer.
  • 11. The waiting time was short. *

    You can give only one answer.
  • 12. It was easy to get a referral when I needed one. *

    You can give only one answer.
  • 13. The person I contacted when making my appointment was polite and respectful. *

    You can give only one answer.
  • 14. The receptionist was friendly. *

    You can give only one answer.
  • 15. The nurses and medical assistants were attentive and caring. *

    You can give only one answer.
  • 16. The people that assisted me with billing and insurance were helpful. *

    You can give only one answer.
  • 17. The lab or X-ray staff were professional. *

    You can give only one answer.
  • 18. My doctor knew my medical history well. *

    You can give only one answer.
  • 19. My doctor listened to me carefully. *

    You can give only one answer.
  • 20. My doctor took the time to answer my questions. *

    You can give only one answer.
  • 21. My doctor spent enough time with me. *

    You can give only one answer.
  • 22. My doctor's explanations and instructions were clear. *

    You can give only one answer.
  • 23. My examination was thorough. *

    You can give only one answer.
  • 24. I found the hours of operation convenient. *

    You can give only one answer.
  • 25. Parking was available and adequate. *

    You can give only one answer.
  • 26. The waiting room was comfortable and the facility was clean. *

    You can give only one answer.
  • 27. Signage and directions were easy to follow. *

    You can give only one answer.
  • 28. [ANS_1], how would you rate the medical care we have provided so far?

    You can give only one answer.
  • 29. How often do you do something (scale from 1 to 7, neutral) *

    You can give only one answer.
  • 30. Could you tell us quickly why you gave us a [ANS_29]?

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