A nursing home satisfaction questionnaire aims at knowing the patients opinion about the care taken by the nursing home during illness. The main aim is to recognize the care and behavior of the nursing home staff including doctors, nurses and support staff. This questionnaire helps a nursing home to run in a better way by identification of areas for improvement.

Sample Nursing Home Satisfaction Questionnaire

Name of the Patient/ Attendant: ______________________

Age:                                            ______________________

Gender:                                       ______________________

Marital Status:                            ______________________

Address:                                      ______________________

Email address:                            ______________________

Profession:                                  ______________________

1)      Have you or any of your relative taken any treatment from our nursing home recently? If yes when?

a)      Yes

b)      No

2)      Do you feel the charges levied by our nursing home are reasonable?


b) No

3) Are the doctors and staff of the nursing home capable of giving good treatment?

a) Yes

b) No

4) Are you happy with the ambience of the nursing home?

a) Yes

b) No

5) Are the medical equipments of the nursing home up-to-date and functioning well during your stay in our nursing home/

a) Yes

b) No

6) Were you well informed about the various medical facilities available in our nursing home?

a) yes

b) No

7) Is there any specific medical service or facility that you would like to change in our nursing home? If you answer yes please specify the same.

a) Yes _________________

b) No

8) Were the doctors and medical staff prompt in attending to you while you were ill?

a) Yes

b) no



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