Healthcare Patient Satisfaction Survey Checklist
Ensure exceptional patient care with our Healthcare Patient Satisfaction Survey Checklist! Streamline feedback collection, identify areas for improvement, and boost your hospital's reputation. Download now and elevate the patient experience!
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Arrival & Registration
Assesses the patient's initial experience upon arrival and during registration.
Arrival Time
Were you greeted promptly upon arrival?
How would you rate the friendliness of the front desk staff?
Please describe any difficulties you experienced during registration.
How long did you wait to be called back from the waiting area (in minutes)?
Was the registration process clear and easy to understand?
Appointment Scheduling
Evaluates the ease and convenience of scheduling appointments.
How easy was it to schedule your appointment?
Original Requested Appointment Date
Scheduled Appointment Date
Scheduled Appointment Time
How satisfied were you with the wait time for your appointment?
Please describe any difficulties you encountered when scheduling your appointment.
Was the reason for your appointment clearly understood during scheduling?
Doctor/Provider Interaction
Focuses on the patient's perception of the doctor's communication, empathy, and professionalism.
How would you rate your doctor’s communication skills?
Did the doctor explain your diagnosis and treatment plan clearly?
Please describe what the doctor did well during your visit.
What could your doctor have done to improve your experience?
Did you feel the doctor listened to your concerns?
On a scale of 1-10 (1 being not at all, 10 being extremely), how would you rate your doctor’s empathy?
Nursing Staff Interaction
Focuses on the patient's perception of the nurses' care, communication, and responsiveness.
How would you rate the nurses' overall friendliness and approachability?
How responsive were the nurses to your needs and requests?
Please describe any specific examples of excellent or poor nursing care you received.
How quickly were nurses able to respond to your calls for assistance (in minutes)?
Which of the following best describe your experience with nurse communication?
Were you comfortable asking nurses questions about your care?
Facility & Environment
Evaluates the cleanliness, comfort, and overall appearance of the healthcare facility.
Rate the cleanliness of the waiting area (1-5, 1=Very Dirty, 5=Spotless)
Rate the comfort of the waiting area seating (1-5, 1=Very Uncomfortable, 5=Very Comfortable)
How would you rate the noise level in the facility?
Which of the following aspects of the facility could be improved? (Select all that apply)
Please provide any specific comments about the facility's environment.
Was the facility easily accessible for people with disabilities?
Treatment & Care
Assesses the effectiveness and quality of the medical treatment received.
How satisfied were you with the treatment you received?
On a scale of 1-10 (1 being very low, 10 being excellent), how would you rate the effectiveness of your treatment?
Please describe your experience with the medical procedures performed.
Were you given clear explanations about your treatment plan?
Were there any complications or unexpected outcomes during your treatment? Please describe.
Did you feel your concerns were adequately addressed by the medical staff?
Discharge & Follow-up
Evaluates the clarity and completeness of discharge instructions and follow-up care plans.
Were discharge instructions clearly explained?
Please describe any difficulties you encountered understanding the discharge instructions.
Date of follow-up appointment (if scheduled)
Scheduled follow-up appointment time (if applicable)
Do you know how to contact the clinic/hospital with questions after discharge?
Any other comments or suggestions regarding your discharge process?
Were you given contact information for support services (e.g., home health, social work)?
Billing & Insurance
Assesses the clarity and transparency of billing practices and insurance handling.
Were billing statements easy to understand?
Estimate of your total bill amount:
Insurance provider:
Were your insurance benefits explained clearly?
Please describe any issues you encountered with billing or insurance:
Did you receive a timely response to your billing inquiries?
Overall Experience
A summary section for overall satisfaction and suggestions for improvement.
Overall Satisfaction (1-10)
Would you recommend our facility to others?
What did you like most about your visit?
What could we have done to improve your experience?
How likely are you to return to our facility?
Optional: Upload any supporting documentation (e.g., photos)
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