Hospital Services - In-Patient example

This is an example Hospital Services - In-Patient survey. This survey includes questions like:

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Registration

Please tell us how satisfied or dissatisfied you were with each of the following.
1) How satisfied were you with the ease of registration?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
2) How satisfied were you with the explanations you received regarding billing procedures?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
3) How satisfied were you with the amount of time it took to complete the registration process?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
Please tell us how much you agree or disagree with each of the following statements.
4) The registration representative was friendly and respectful.
5) The registration representative fully answered all my questions.

Nursing Staff

Please tell us how satisfied or dissatisfied you were with each of the following.
6) How satisfied were you with the friendliness of the nursing staff?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
7) How satisfied were you with the professionalism of the nursing staff?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
8) How satisfied were you with the frequency with which the nurses checked on you while you were an in-patient in this hospital?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
Please tell us how much you agree or disagree with each of the following statements.
9) My nurse fully answered my questions about my treatment.
10) My nurse fully explained the procedures for my release from the hospital.
11) My nurse was knowledgeable about my treatment.

Doctor Care

12) How would you rate the quality of the care you received from your doctor while you were an in-patient in this hospital?
  • Excellent
  • Good
  • Fair
  • Poor
  • Undecided
13) How satisfied were you with the frequency of visits our received from your doctor while you were an in-patient in this hospital?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
Please tell us how much you agree or disagree with each of the following statements.
14) My doctor fully explained the procedures of my treatment.
  • Strongly Disagree
  • Disagree
  • Undecided
  • Agree
  • Strongly Agree
15) My doctor fully answered all my questions.
  • Strongly Disagree
  • Disagree
  • Undecided
  • Agree
  • Strongly Agree
16) My doctor provided me with high quality care.
  • Strongly Disagree
  • Disagree
  • Undecided
  • Agree
  • Strongly Agree

Other

17) How satisfied were you with the visitor policy at the hospital?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
18) How satisfied were you with your menu choices?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
19) How satisfied were you with the television equipment and programming in your room?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
20) How satisfied were you with the quality of the food?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
21) Overall, how satisfied were you with the quality of the care you received while an in-patient at this hospital?
  • Very Satisfied
  • Somewhat Satisfied
  • Undecided
  • Somewhat Dissatisfied
  • Very Dissatisfied
22) Would you recommend this hospital to others?
  • Yes
  • No
  • Undecided
23) Please tall us what, if anything, we can do to improve our services,
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