Templates Health & Wellness Hospital Patient Satisfaction Survey Form Template

Hospital Patient Satisfaction Survey Form Template

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Personal Details

Name

Admission Information

Quality of Care

Rate the following aspects of your care on a scale from 1 (Very Unsatisfied) to 5 (Very Satisfied)
Likert Scale
12345
Nursing Staff's Attentiveness
1
2
3
4
5
Doctor's Communication
1
2
3
4
5
Speed of Service
1
2
3
4
5
Clarity of Treatment Information Provided
1
2
3
4
5

Facilities and Environment

Rate the following on a scale from 1 (Very Unsatisfied) to 5 (Very Satisfied)
Likert Scale
12345
Cleanliness of Hospital
1
2
3
4
5
Comfort of Patient Rooms
1
2
3
4
5
Quality of Food Provided
1
2
3
4
5
Ease of Navigation
1
2
3
4
5

Overall Experience

Selected Value: 5

Additional Comments

Please share any other comments or suggestions to help us improve our services.

Introducing the Hospital Patient Satisfaction Survey Form Template from WPForms, which helps assess and enhance the quality of care and overall patient experiences.

If you’re looking for a patient feedback template, this is for you.

How Does the Hospital Patient Satisfaction Survey Form Template Work?

When hospitals prioritize patient feedback, they show they care and get a roadmap for improvement. The Hospital Patient Satisfaction Survey Form is adept at collecting significant patient insights. Let’s take a look into the intricacies of this form:

Starting off, it comes with a Personal Details section. Here, users will gather the patient’s essential details such as name, email, unique patient ID, age, and gender, ensuring that feedback is cataloged correctly and can be tied back to specific care incidents.

Then, the form touches upon the Admission Information. This section aims to provide context to the feedback by capturing data about the department or unit the patient was treated in, alongside their admission and discharge dates. This allows for a comprehensive understanding of the care duration and involved departments.

Crucial to the feedback process, the Quality of Care section employs a Likert scale. This method makes it easy to gauge a patient’s level of satisfaction in key areas like the attentiveness of nursing staff, the doctor’s communication abilities, the promptness of service, and the clarity of treatment information given.

The Facilities and Environment section further enhances the feedback granularity. Once more, using the Likert scale, it evaluates elements intrinsic to a patient’s comfort and safety, such as the cleanliness of the hospital, the ambiance of patient rooms, the caliber of meals offered, and even the ease of navigating the hospital’s premises.

Building on this, the Overall Experience segment gives a holistic view of the patient’s journey. With a simple question, users can find out if patients would endorse the hospital to peers. Additionally, the slider for overall satisfaction offers a swift yet detailed method to gauge a patient’s overall sentiment.

Lastly, the Additional Comments section acts as a free space. Here, patients can share bespoke feedback, suggestions, or noteworthy experiences that could prove pivotal in refining care standards and hospital services. Bear in mind this template uses the Survey and Polls Addon that requires the WPForms Pro license.

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Sign up with WPForms today and incorporate our Hospital Patient Satisfaction Survey Form Template to amplify patient care and foster a culture of continuous improvement in your medical facility. Elevate your quality of care, patient experience, and reputation!