A medication satisfaction questionnaire is a programmed survey which is being fetched in front of the patients to rate their satisfaction level of medication procedures. By collecting the feedback of patients, a medical institution can evaluate the proficiency level of their doctors and the current status of their overall medical facilities.  In the other words, such a questionnaire proves highly beneficial for the medical organizations to improve their treatment and infrastructure.

Sample Medication Satisfaction Questionnaire:

Name of the patient: _____________________

Sex: ___________________________________

Type of treatment: ______________________

Name of the doctor: _____________________

Q1. Kindly specify the category of your disease for which you are under medication:

  • Cardiovascular
  • Neurological
  • Diabetic
  • Infection
  • Others, _______________

Q2. Has the doctor educated you about the symptoms and causes of your disease before recommending you for medication?

  • Yes. Absolutely
  • No

Q3. Please write the name of the medicines you are taking for curing the above mentioned disease?


Q4. Are you facing any allergic sensation with these drugs?

  • Yes
  • Sometimes
  • No
  • If yes, please write the about it: _______________

Q5. Has the doctor ever changed your medicines during the treatment?

  • Yes. Many times
  • Sometimes
  • Not at all

Q6. How often do you visit this hospital for regular check- ups?

  • Once in a week
  • Once in ten days
  • Once in fifteen days
  • Once in a month

Q7. Do you feel satisfied with the behaviour of the concerned doctor and the medical staff?

  • Yes
  • Somewhat satisfied
  • No

Q8. How do you rate our overall facilities of the medication department?

  • Outstanding
  • Very good
  • Average
  • Not satisfactory

Q9. Are you feeling satisfied with the overall medication system?

  • Yes
  • No

Q10. Would you like to suggest us something to improve our mediation system and the facilities?