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.
More Articles on Patient Satisfaction:
7 Ways to Improve Consumer Satisfaction
The Role of Anesthesia in Patient Satisfaction: 7 Key Responsibilities
3 Points on Conducting Patient Surveys
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