Patient Communication Effectiveness Evaluation Form
Please evaluate the effectiveness of communication during your recent visit.
Please rate the clarity of the information provided by the healthcare provider.
1
1
2
3
4
Best
5
1 is , 5 is Best
Please rate the responsiveness of the healthcare provider to your questions and concerns.
2
1
2
3
4
Best
5
1 is , 5 is Best
Please rate the empathy and understanding shown by the healthcare provider.
3
1
2
3
4
Best
5
1 is , 5 is Best
Please provide any additional comments or feedback regarding communication.
Submit
Should be Empty: