Hospice Patient Satisfaction Survey

This survey measures how patients perceive the care they received during their stay. Respondents rate statements about comfort and treatment, give an overall score, and say whether the referral that brought them there was suitable and timely. Leaving a name is optional, so answers can stay anonymous.

Use this template

In the Claude connectors directory

If you think something should be done differently, write it here

Was the referral to the hospice appropriate?

Yes No Not sure

Was the referral made in good time?

Yes No Not sure

Additional comments or questions

How long have you been here?

Less than a week Between one and four weeks Between one and three months More than three months

Gender

Female Male Other Prefer not to say

Name (optional)

First Name

Last Name

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