Patient discharge feedback

Patient feedback after discharge: instruction clarity, staff care, and NPS.

Use this template

How was your stay?

Your feedback is anonymous if you prefer — the email at the end is optional.

Discharge date

Area where you were treated

Rate the following aspects

Did you understand your medications and care plan when leaving?

Yes, completely Partially — I still had questions No

What could we have done better?

Did anyone on the team make your stay special?

We love recognizing our staff — tell us who and why.

Email (optional — if you'd like us to follow up)

	Poor	Fair	Good	Excellent
Clarity of discharge instructions
Kindness of the nursing staff
Communication from the physicians
Pain management
Cleanliness of the facilities
Waiting times