Patient Satisfaction survey template

July 4, 2011

A patient satisfaction survey template is a format written for satisfaction survey conducted for patients of any medical organization. These templates prove to be useful when a huge number of such surveys have to be conducted for the purpose of evaluation.

Sample patient satisfaction survey template

Name: __________________ (Mention the name of the patient taking survey)
Age: __________________ (Mention the age of the patient)
Gender: ___________________ (Mention the gender of the patient)
1. The first question should be about an overall rating of the satisfaction with the hospital and its staff
a) _____________ (provide rating option here)
b) ____________
c) _____________
d) ______________
2. This question should ask whether the medication provided is bringing about any improvement to the patient or not
a) ___________ (provide options yes/no)
b) ___________
3. This question ask whether the patient has been provided with knowledge and consequences of the ailment he/she is suffering from
a) _______________ (provide options yes, no and partially)
b) _______________
c) _______________
4. This question is about asking whether the patient checks injections and medicines for their expiry date
a) _______________ (provide options yes/no)
b) ______________

Download Patient Satisfaction survey template in Word Format

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