Patient Satisfaction Survey Template

Dear valued patient,


We hope this message finds you well. We would like to invite you to participate in our Patient Satisfaction Survey to help us improve our services and better meet your needs. Your feedback is highly appreciated and will be kept confidential. Thank you for taking the time to share your thoughts with us.
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1.
Please choose the department for your treatment.
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2.
Overall, how satisfied are you with the care you received during your visit?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
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3.
How would you rate the friendliness and professionalism of the doctor?
Excellent
Good
Fair
Poor
Very poor
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4.
How would you rate the cleanliness and comfort of the facilities?
Excellent
Good
Fair
Poor
Very poor
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5.
How well did the doctor explain your condition and treatment options to you?
Very well
Somewhat well
Neutral
Somewhat poorly
Very poorly
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6.
How would you rate the wait time for your appointment?
Excellent
Good
Fair
Poor
Very poor
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7.
How likely are you to recommend our hospital to a friend or family member?
Impossible
Very Likely
8.
Is there anything else you would like to share about your experience?
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