Hospital Satisfaction Questionnaire


A hospital satisfaction questionnaire is primarily structured to evaluate the needs of the patient and his family members as well as to record their satisfaction level with the facilities and services offered at the hospital. A hospital satisfaction questionnaire is essential as it encompasses the patient’s view of the systems in place.

Sample Hospital Satisfaction Questionnaire

Name: ________________________________________________________

Date of admission: _______________________________________________

Date of discharge: _______________________________________________

Doctor in charge: ________________________________________________

Q1: On a scale of ten, how would you rate the hygiene and cleanliness of the hospital, keeping in mind the outdoor space as well as the cabins and inner chambers?

  1. 0-3
  2. 4-6
  3. 7-10

Q2: Which place of the hospital did you find needs better cleaning and hygiene?

________________________________________________________________________________________________________________________________________________

Q3: How would you assess your monetary charges for treatment? Would you consider some of the tests as extraneous?

________________________________________________________________________________________________________________________________________________

Q4: How would you evaluate the quality of food served to you during the duration of your stay as a patient here?

a. Excellent

b. Decent

c. Dissatisfactory

d. Any other comments: ____________________________________________________________________________________________________________________________________

Q5: Are you satisfied with the level of care offered by our staff members? Do you have any specific complaints?

________________________________________________________________________________________________________________________________________________

Q6: Would you recommend this hospital to your acquaintances? What would you consider our area of expertise?

________________________________________________________________________________________________________________________________________________

Q7: Are you satisfied with your doctor in charge?

a. Yes most definitely

  1. No

Q8: If you have chosen “no” as your answer to the last question, please state the reason.

________________________________________________________________________________________________________________________________________________

Q9: Would you like to make any other suggestions for the improvement in the services offered at the hospital? ________________________________________________________________________________________________________________________________________________

Category: Satisfaction Questionnaire

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