Patient Satisfaction Survey Form

Are you satisfied with the explanations provided regarding the costs?

How was the attitude and behavior of the admission staff toward you?

How was your waiting time for file/record registration?

Are you satisfied with the behavior of the hospital discharge unit staff?

Are you satisfied with the education and explanations provided by the physician during treatment and at discharge?

Are you satisfied with the nurse’s behavior at the beginning of the shift and during care?

Are you satisfied with the care education provided during treatment and after discharge (follow-up)?

How much education did you receive from the nurse regarding diet and medication use?

Are you satisfied with the confidentiality of information, protection of privacy, patient coverage, and compliance policies in this center?

Are you satisfied with the facilities, equipment, and staff performance of this center? If your answer is negative, please provide constructive suggestions and recommendations.

Are you satisfied with the place and facilities provided for religious practices?

Are you satisfied with your discharge process?

Were the necessary conditions for your hospitalization adequate? (Hygiene, ventilation)

How was the cleanliness of the rooms and sanitary facilities?

How was the attitude and behavior of the security staff?

How was the behavior and guidance of the insurance and financial officers?

How was the behavior of the discharge unit staff?

How was the waiting time for discharge and receiving the invoice (if needed)?

Which area did you experience the highest level of satisfaction and dissatisfaction with?

If needed, would you visit this clinic again?

Would you recommend this clinic to your family and friends if needed?