Patient Satisfaction Template 1 -Form Fill
1.1
Did you face any difficulty while admission in the hospital?
Yes, I did
Somewhat
No, not at all
1.2
During your stay in the hospital, were nurses helpful and polite with you?
Yes, they were extremely polite and helpful.
They were polite and helpful.
No, they were not at all polite and helpful.
1.3
How would you rate the cleanliness and hygiene of the hospital?
The hospital was extremely clean
Hospital was clean to some extent
It was not at all clean
1.4
Were doctor’s patient and skilled enough in listening to your problems and providing with an appropriate treatment?
Yes, they were extremely skilled and patient
They were skilled and patient only to a certain extent.
They were not at all polite and skilled.
1.5
Do you think our hospital have enough space for visitor’s stay?
Yes, it does
Somewhat
No, not at all
1.6
Are you satisfied with the quality of the food?
Yes, I am
Somewhat
No, I’m not satisfied
1.7
Do you think the dietitian and laboratory staff of our hospital are skilled enough?
Yes
Can’t say
No
1.8
What do you think about our parking facility?
Parking facility is good.
It is average.
It is not at all convenient.
1.9
How would you rate your overall experience with us?
It was good
It was average
It was bad
1.10
Will you suggest our healthcare services to any of your friend or family member?
Yes, I will
Maybe
No, I won’t
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