Patient Safety Tool: Sample Patient Satisfaction Survey
The sample form was developed in partnership with SullivanLuallin Healthcare Consulting. The survey allows patients to rate line items under the following categories:
• The appointment
• The staff
• Communication with healthcare providers and staff
• The visit with clinicians
• The facility
• Overall satisfaction
The survey also allows space for patients to provide feedback.
Download the sample patient satisfaction survey (PDF) for use in your facility.
Note: View our database providing 150 reports that link to free, downloadable and adaptable tools for use in surgery centers, hospitals and other organizations by clicking here.
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