Patient Satisfaction Survey

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0

First Name

Last Name
0

Age
0

Height
0

Weight
0

Which department did you visit?
Accident and emergency (A&E)

Cardiology

Diagnostic Imaging

Ear nose and throat (ENT)

Gastroenterology

Gynecology

Neonatal

Oncology

Orthopaedics

Pediatrics

Physiotherapy

Urology

Other (Please specify)
0

Name of doctor visited:
0

Rate your satisfaction for the following:
Ease of making appointments

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Waiting time to see the doctor

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Explanation of the procedure

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Cleanliness of the hospital/clinic

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Fees for treatment

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Ease of making appointments

Waiting time to see the doctor

Explanation of the procedure

Cleanliness of the hospital/clinic

Fees for treatment

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied
0

Rate your satisfaction with the care given by your doctor for the following aspects:
Making you feel at ease

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Willingness to listen to you in detail

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Answering all your questions patiently

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Attitude towards you

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Giving you advise on improving your health

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Thoroughness of the examination

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Explaining your treatment procedure in a way you can understand

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Instruction regarding your medication and follow-up visit

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Making you feel at ease

Willingness to listen to you in detail

Answering all your questions patiently

Attitude towards you

Giving you advise on improving your health

Thoroughness of the examination

Explaining your treatment procedure in a way you can understand

Instruction regarding your medication and follow-up visit

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied
0

Overall, how happy were you with the care given to you?
Not at all

Slightly

Moderately

Very

Extremely
0

Do you have health insurance?
Yes

No
0

Which type?
0

How likely are you to recommend this hospital/clinic to your family and friends?

Not at all

Extremely

0 1 2 3 4 5 6 7 8 9 10
0

Comments

0 / 5000

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0

First Name

Last Name
0

Age
0

Height
0

Weight
0

Which department did you visit?
Accident and emergency (A&E)

Cardiology

Diagnostic Imaging

Ear nose and throat (ENT)

Gastroenterology

Gynecology

Neonatal

Oncology

Orthopaedics

Pediatrics

Physiotherapy

Urology

Other (Please specify)
0

Name of doctor visited:
0

Rate your satisfaction for the following:
Ease of making appointments

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Waiting time to see the doctor

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Explanation of the procedure

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Cleanliness of the hospital/clinic

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Fees for treatment

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Ease of making appointments

Waiting time to see the doctor

Explanation of the procedure

Cleanliness of the hospital/clinic

Fees for treatment

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied
0

Rate your satisfaction with the care given by your doctor for the following aspects:
Making you feel at ease

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Willingness to listen to you in detail

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Answering all your questions patiently

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Attitude towards you

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Giving you advise on improving your health

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Thoroughness of the examination

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Explaining your treatment procedure in a way you can understand

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Instruction regarding your medication and follow-up visit

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied

Making you feel at ease

Willingness to listen to you in detail

Answering all your questions patiently

Attitude towards you

Giving you advise on improving your health

Thoroughness of the examination

Explaining your treatment procedure in a way you can understand

Instruction regarding your medication and follow-up visit

Extremely dissatisfied

Dissatisfied

Neutral

Satisfied

Extremely satisfied
0

Overall, how happy were you with the care given to you?
Not at all

Slightly

Moderately

Very

Extremely
0

Do you have health insurance?
Yes

No
0

Which type?
0

How likely are you to recommend this hospital/clinic to your family and friends?

Not at all

Extremely

0 1 2 3 4 5 6 7 8 9 10
0

Comments

0 / 5000