Hospice Patient Satisfaction Survey
It can be filled out by the patient or his/her family/representatives. The final results will assist us in determining which services of the Hospice require improvement. The data collected from this survey will be analyzed as a group to ensure confidentiality and anonymity.
Please rate how satisfied are you with the following statements
the care you received from the health care provider?
the frequency of the health care provider’s visits?
the time the health care provider spent with you during visits/consultation?
the care received by you from the nurses?
the emotional support that was provided
by the nurses?
how quickly the nurses answered the buzzer?
the information were given to you about your
illness and treatment?
your involvement in decisions about their care?
the food service?
the cleanliness of the unit?
the level of noise?
the temperature of the unit?
the management of pain?
the management of other symptoms?
(nausea, vomiting, constipation, etc.)
the observance of your wishes
Overall, please rate the hospice
1 is Worst, 5 is Best
If you have anything you think should be done differently, please write below
Was the referral to the hospice appropriate?
Was the referral made in a timely manner?
Additional comments or questions
How long have you stayed here?
Less than 1 month
More than 3 years
Don't want to specify
Should be Empty: