Patient Satisfaction Survey

Your feedback helps us improve

Patient Name (optional)

Phone *

Reason for Visit

Overall Satisfaction

Not rated

How likely are you to recommend us to a friend or family member?

Score from 0 (not at all likely) to 10 (extremely likely)

Detractors (0-6)Passives (7-8)Promoters (9-10)

Wait Time

Staff Friendliness

Cleanliness

Quality of Care

I would recommend this facility to my family and friends

What did you like most about your visit?

What can we improve?

Additional Comments

How satisfied were you with the waiting time at the front desk?

How would you rate the nurses` attitude and friendliness?

Did you feel respected and comfortable with the doctor?

How would you rate the courtesy and professionalism of the laboratory staff?

Were you given clear instructions before your laboratory test?

How satisfied were you with the waiting time at the pharmacy?

Were the intructions for taking your medication explained clearly?

How would you rate your overall experience at our hospital?

Your response is confidential and will be used to improve our services.