Hospital Evaluation Survey
Hospital Evaluation Survey
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How satisfied were you with the care you received during your hospital stay?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
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How would you rate the overall cleanliness of the hospital?
Excellent
Very Good
Good
Fair
Poor
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How would you rate the quality of the food provided during your hospital stay?
Excellent
Very Good
Good
Fair
Poor
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How would you rate the comfort of your hospital room?
Excellent
Very Good
Good
Fair
Poor
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How would you rate the communication from hospital staff during your stay?
Excellent
Very Good
Good
Fair
Poor
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Were you given enough information about your diagnosis and treatment options during your hospital stay?
Yes
No
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If you answered "No" to the previous question, please explain briefly:
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Were the hospital staff respectful and considerate of your needs and preferences during your stay?
Yes
No
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If you answered "No" to the previous question, please explain briefly:
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How would you rate the overall quality of care you received during your hospital stay?
Excellent
Very Good
Good
Fair
Poor
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Would you recommend this hospital to family or friends?
Definitely
Probably
Neutral
Probably Not
Definitely Not
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Is there anything that could have been done to improve your hospital experience? If yes, please explain briefly:
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How did you hear about this hospital?
Doctor Referral
Internet Search
Word of Mouth
Advertisement
Other (please specify)
Other (please specify)
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