Patient Health Outcomes Follow-up Survey Template

10
Questions
Use This Template

Patient Health Outcomes Follow-up Survey Template

Thank you for taking the time to complete our follow-up survey. Your feedback is crucial in helping us improve our care and services. This survey should only take a few minutes of your time.
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*
1.
How would you rate your overall health now compared to before your treatment/procedure?
Much better
Somewhat better
About the same
Somewhat worse
Much worse
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2.
Since your last visit, have you experienced any of the following symptoms?
[Checkboxes]
Pain
Fatigue
Difficulty sleeping
None of the above
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3.
How satisfied are you with the improvement in your condition following your treatment/procedure?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
*
4.
How effectively did our medical team communicate the nature and expected outcomes of your treatment/procedure?
Very effectively
Somewhat effectively
Not effectively
I did not receive any explanation
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5.
Did you feel involved in the decision-making process regarding your treatment options?
Yes, very much so
Somewhat
Not really
Not at all
*
6.
How would you rate the quality of care and service provided by our staff during your visit(s)?
Excellent
Good
Average
Poor
Very Poor
*
7.
How likely are you to recommend our facility to friends and family for similar care?
Very likely
Likely
Neutral
Unlikely
Very unlikely
*
8.
What aspect of your care do you believe requires improvement?
[Checkboxes]
Quality of medical care
Communication and information provided
Wait times
Facility cleanliness and comfort
Staff friendliness and professionalism
Other
*
9.
Since your treatment/procedure, how many times have you had to seek medical attention for the same condition?
Not at all
Once
2-3 times
More than 3 times
10.
Do you have any additional comments or suggestions that could help us improve our patient care?
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