Surveyonics - Online Survey Software

Measuring Patient Satisfaction
For your convenience and ease of reference, we have created a template of Medical Patient Satisfaction Survey. You can use this template as such or modify it to suit your needs. Alternatively, you can design your own survey from scratch.

 Question: How did you find our healthcare provider(s) in the following areas?
He/She listened to your problems and showed concern for those problems
He/She explained the things to you in a way you would understand
He/She was very patient and discussed your problem in detail
 Question: In which department were you seen by a health care provider in your recent visit to the hospital?
Family Practice
Internal Medicine

Any other, please specify
 Question: What do think regarding the hospital's facilities in the following areas?
Strongly agreeModerately agreeNot sureModerately disagreeStrongly disagree
The staff gives clear information
The staff is well informed and knowledgeable
The appointment times are usually convenient
The interaction with the healthcare providers is good
The billing procedures are hassle free
The referrals to a specialist are handled in a timely way
The patients are the top priority for the hospital staff
 Question: Which age group do you fall into?
Below 20
21 to 30
31 to 40
41 to 50
51 to 60
61 to 70
70 to 80 and above
 Question: What would you say about the person handling the phone queries?
Very prompt
Gave the advice needed
Well informed
Not well informed

 Question: Are you able to schedule your appointment in a reasonable amount of time?

 Question: Please specify your gender.
 Question: How much time do you have to usually wait before you can see the healthcare provider?
 Question: What will be the reason for you to refer a friend or family members to our hospital?
 Question: How many times have you availed the healthcare facilities offered by our hospital in the past?