Patient satisfaction survey
Dear Patient,
Thank you for visiting our medical facility. Please take a moment to fill in this short patient satisfaction survey. The results of this questionnaire will be utilized by us so we can refine your patient experience.
1) What is your gender?*

2) What is your age?*

3) What is your satisfaction with following aspects of our facilities?*

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfied
Cleanliness
Comfort
Location
Parking
Privacy and safety
Ease of orientation (signposts and labels)
4) How satisfied are you with these time related aspects related to your medical appointment?*

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfied
Facility opening hours
Available time slots for your medical appointment
Time spent in the waiting room
Punctuality of the appointment start time
Procedure duration
Test results availability delay
5) How satisfied are you with these procedure related aspects of your medical appointment?*

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfied
Your needs being heard
Your questions being answered
Explanation of possible treatment options
Procedure itself
Follow up care explanation
6) How satisfied are you with the attitude of our personnel?*

7) How do you perceive price of our medical services?*

8) Overall, how satisfied were you with your last visit to our medical facility?*

9) How likely is it for you to recommend our medical facility to the people you know?*



*Answer required

Created with free online survey tool AkioSurvey