Hospital Satisfaction Survey

Find out how people rate nurses, doctors, room comfort, appointment scheduling and waiting times after they leave your care. A mix of scales, star ratings and one open question gives service teams both hard numbers and the story behind them.

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Patient Name

Nombre

Apellido

Birth Date

Phone Number

3) How satisfied are you with the comfort of your room?

5) How many times have you visited the hospital?

This is my first visit 2 to 3 times 4 to 6 times More than 6 times

6) Do you have a health insurance plan?

Yes No Not sure

7) Please rate how satisfied you are with the process of scheduling an appointment with your doctor

8) How long did you have to wait to see the doctor (beyond your scheduled appointment time)?

Less than 15 minutes 15 to 30 minutes 30 to 60 minutes More than an hour

9) Are you informed of all of the healthcare services we provide?

Yes, I know them all Only some of them No, I do not

10) What else would you like to tell us about?

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