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? __________________________________________________________
