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Patient / Companion Satisfaction Survey Form for Inpatient Ward

We kindly ask you to share your feedback to help us improve the quality of hospital services. We sincerely appreciate the time you dedicate to completing this form.

    Name and surname of the form filler (Optional)

    Contact number (Optional)

    Completed by

    Gender

    Age

    Education

    Number of hospitalizations

    Questions

    Answer

    Are you satisfied with the behavior and responsiveness of the reception supervisor?

    Are you satisfied with the interaction and response of the security staff?

    Are you satisfied with the interaction and response of the reception and cashier staff (regarding contracted insurance, medical expenses, etc.)?

    Are you satisfied with the interaction and response of the laboratory staff?

    Are you satisfied with the interaction and response of the emergency staff?

    Are you satisfied with the interaction and response of the emergency doctor?

    Are you satisfied with the speed and ease of the inpatient admission process?

    Are you satisfied with the quantity and quality of the hospital meals?

    Are you satisfied with the interaction of the hospital cafeteria staff?

    Are you satisfied with the general cleanliness (room cleanliness, restroom, and public areas)?

    Are you satisfied with the facilities provided for personal hygiene (hygiene kit, bedding, clothing, etc.)?

    Are you satisfied with the interaction and response of the department service staff?

    Are you satisfied with the interaction and response of the psychology staff?

    Are you satisfied with the interaction and response of the treating doctor?

    Are you satisfied with the interaction and response of the nursing staff in the department?

    Are you satisfied with the training provided in the department upon arrival, during hospitalization, and at discharge?

    Are you satisfied with the interaction and response of the department's receptionist?

    Are you satisfied with the speed and ease of the patient discharge process?

    Are you overall satisfied with this hospital?

    Would you recommend this hospital to your friends and acquaintances?