Communication Questionnaire


Communication can be described as the lifeline of human interaction. Many problems arise when there is a failure to effectively communicate. A communication questionnaire evaluates this critical aspect of life. The purpose of a communication questionnaire is to determine how well people communicate and how they go about it. It considers the importance of communication.

Sample Communication Questionnaire

Name ……………………………………………………………………………………

Date ………………………………………………………………..

Answer yes or no to the following questions

Did the doctor speak in a way that you could understand? _________

Did the doctor make eye contact with you?  _______________

Did the doctor ask you about your background?  ____________

Was the doctor actively listening to you?  _________________

Did the doctor provide relevant answers to your questions?   ____________

Was the doctor attentive as you spoke?  ________________

Did the doctor take time to address your concerns?  _______________

Did the doctor give you details about your condition?  ______________

Did the doctor ask you about your concerns?  ___________________

Was the doctor interested in knowing how you felt about your treatment options?  ____________

Did the doctor give you enough time to ask questions?  ______________

Did the doctor seem willing to spend time with you?  ________________

Was the doctor patient during the consultation?  _________________

Did the doctor provide you with any written material?  __________________

Did the doctor undermine any of your personal beliefs?  _________________

How comfortable were you during your consultation with the doctor?

…………………………………………………………………………………………………………..

How well did the doctor communicate with you?

…………………………………………………………………………………………………

Do you think the doctor should improve his communication skills? __________________________________________________________

Category: Management Questionnaire

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