A hospital patient satisfaction questionnaire is created to find out what or how patients feel about the medical care provided by a hospital and also about the behavior of the medical staff towards treatment of patients. A hospital patient satisfaction questionnaire helps a medical institution to identify areas that they need to improve upon and what other medical care services they need to offer their patients.

Hospital Patient Satisfaction Questionnaire Sample

Name of the Individual: ____________________________________ Date: _____________

Sex: __________  Age: ___________  Marital Status: _______________

Address: ___________________________________________________

City: ________________ State: ______________  Zip: ______________

Telephone: ____________________  Email: ________________________

Name of the hospital: _____________________________________

Q1. Have you received treatment in this hospital before?

a)   Yes

b)   No

Q2. How do you rate the medical care costs of the hospital as compared to others?

a)   It is the most expensive

b)   It is costlier than most

c)   It is among the costliest

d)   It is not as costly as others

e)   It charges one of the lowest medical fees

f)    Can’t say

Q3. Are the doctors and medical staff of this hospital competent?

a)   Yes

b)   No

Q4. Which of the following aspects of this hospital are good according to you?

a)   Good infrastructure

b)   Knowledgeable staff

c)   Competent doctors

d)   Highly Professional staff

e)   Organized

f)    State of the art equipments

g)   No long queue for outpatients

h)   Easy accessibility to medical care

Q5. Which of the following did you experience in the hospital?

a)   You were kept informed

b)   Proper diagnosis and explanation

c)   Proper information about treatment

d)   Response to nurse call

e)   Availability of doctors

f)    Availability of medicines

g)   Awareness of your medical condition

h)   Overall high standard of care

Q6. Do you have any suggestions for patient satisfaction?