Hospital Performance Evaluation Survey

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0

Rate your satisfaction level with the following aspects of the facility:

Very dissatisfied

Very satisfied

State of technology

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Cleanliness

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Orderliness

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Staff management

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Patient management

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Service

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied
0

Were you admitted into the hospital?
Yes

No
0

What was the reason for admission?
0

How effective was the healthcare administered?
Unsatisfactory

Poor

Fair

Good

Excellent
0

How thorough were the doctors during the checkup?
Not at all

Slightly

Moderately

Very

Extremely
0

Were clear explanations provided before treatment?
Yes

No
0

Please elaborate

0 / 5000
0

How effective was the pharmaceutical service?
Unsatisfactory

Poor

Fair

Good

Excellent
0

How friendly were the pharmacists?
Not at all

Slightly

Moderately

Very

Extremely
0

Did the pharmacist listen to your concerns before finding treatment?
Yes

No
0

Please elaborate

0 / 5000
0

Was the pharmacist’s explanation of your medication clear?
Yes

No
0

Please elaborate

0 / 5000
0

How easy was the hospital to navigate?
Not at all

Slightly

Moderately

Very

Extremely
0

How satisfied are you with the overall experience?
Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied
0

How can we improve?

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0

Rate your satisfaction level with the following aspects of the facility:

Very dissatisfied

Very satisfied

State of technology

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Cleanliness

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Orderliness

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Staff management

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Patient management

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied

Service

Very dissatisfied

Very satisfied

1 Very dissatisfied

2

3

4

5 Very satisfied
0

Were you admitted into the hospital?
Yes

No
0

What was the reason for admission?
0

How effective was the healthcare administered?
Unsatisfactory

Poor

Fair

Good

Excellent
0

How thorough were the doctors during the checkup?
Not at all

Slightly

Moderately

Very

Extremely
0

Were clear explanations provided before treatment?
Yes

No
0

Please elaborate

0 / 5000
0

How effective was the pharmaceutical service?
Unsatisfactory

Poor

Fair

Good

Excellent
0

How friendly were the pharmacists?
Not at all

Slightly

Moderately

Very

Extremely
0

Did the pharmacist listen to your concerns before finding treatment?
Yes

No
0

Please elaborate

0 / 5000
0

Was the pharmacist’s explanation of your medication clear?
Yes

No
0

Please elaborate

0 / 5000
0

How easy was the hospital to navigate?
Not at all

Slightly

Moderately

Very

Extremely
0

How satisfied are you with the overall experience?
Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied
0

How can we improve?