Service User Satisfaction Questionnaire


A service user satisfaction questionnaire is most commonly used in the health care industry and is often provided to patients or individuals who regularly use health care services and facilities. The benefits derived from using a service user satisfaction questionnaire include knowing what the receiver of services needs, knowing their measurement of quality service, the problem areas etc. The feedback helps the health care industry to improve upon their existing services. A service user satisfaction questionnaire can be used by just about any service industry.

Sample Service User Satisfaction Questionnaire:

Name of the Participant: _____________________________

Gender: _________________ (M/F)   Age: ______________

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Did you visit a health care provider in the last 3 months?

a)      Yes

b)      No

c)      Don’t Know

  • Did your visit to the health care provider bear positive results?

a)      Yes

b)      No

c)      Not sure

  • How satisfied are you with the various services being offered by the health care provider?

a)      Extremely satisfied

b)      Somewhat satisfied

c)      Satisfied

d)     Neutral

e)      Dissatisfied

f)       Somewhat dissatisfied

g)      Extremely dissatisfied

  • Are you satisfied with the information offered by the health care provider regarding the particular care or service you opted?

a)      Extremely satisfied

b)      Somewhat satisfied

c)      Satisfied

d)     Neutral

e)      Dissatisfied

f)       Somewhat dissatisfied

g)      Extremely dissatisfied

  • Are you completely satisfied with the attitude of the staff at the health care provider’s facility? (Please mention the improvements that can be made. Quote specific examples)

a)      Extremely satisfied

b)      Somewhat satisfied

c)      Satisfied

d)     Neutral

e)      Dissatisfied

f)       Somewhat dissatisfied

g)      Extremely dissatisfied

Improvements:_____________________________________________________

  • What is your overall satisfaction level regarding the quality of care offered here?

a)      Extremely satisfied

b)      Somewhat satisfied

c)      Satisfied

d)     Neutral

e)      Dissatisfied

f)       Somewhat dissatisfied

g)      Extremely dissatisfied

Category: User Questionnaire

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