Patient Satisfaction Template 2 -Form Fill
1.1
Choose one option from each category- Cleanliness of hospital
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.2
Choose one option from each category- Attentiveness of nurses
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.3
Choose one option from each category- Attentiveness of doctors
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.4
Choose one option from each category- Availability of medication
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.5
Choose one option from each category- Staying facility for family members
Extremely satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Extremely dissatisfied
1.6
Do you think our doctors are skilled enough in treating you?
Yes
No
1.7
Do you think you were provided with all the required facilities during your stay?
Yes
Somewhat
No
1.8
Do you think the pillows and bedsheets in your room were clean and tidy?
Yes
Somewhat
No
1.9
How would you rate the overall facilities provided to you during your stay? (out of 5)
1 being least satisfied
2
3
4
5 being most satisfied
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