Patient Satisfaction Template 5 -Form Fill
1.1
During your stay in our hospital, were you satisfied with the cleanliness of your room and hospital?
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.2
Do you think all the equipment’s available in our hospital are of good standards?
Yes
Somewhat
No
1.3
Do you think the pillows and bedsheets of your room were clean and tidy?
Yes
Somewhat
No
1.4
Was your room regularly cleaned?
Yes
At times
No
1.5
Do you think our cleaning staff do their work efficiently?
Yes
Somewhat
No
1.6
Are you satisfied with the cleanliness of our hospital?
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Extremely satisfied
Dissatisfied
1.7
Do you think the food was provided to you on time?
Yes
No
1.8
Do you think the food was made in clean and hygienic environment?
Yes
Somewhat
No
1.9
Do you think the food provided to you was healthy?
Yes
Somewhat
No
1.10
Are you satisfied with the food given at our hospital?
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Extremely satisfied
Dissatisfied
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