Hospital Administration Configuration Feedback Form
Share feedback on hospital administration setup, workflow, and configuration so improvements can be prioritized. Please keep the form focused on administrative settings and operational experience, not medical or sensitive health information.
Respondent and Context
Respondent Name
First Name
Middle Name
Last Name
Department or Unit
Please Select
Administration
Admissions
Billing
Compliance
Facilities
IT / Informatics
Medical Records
Operations
Patient Access
Quality Improvement
Scheduling
Other
Role / Title
Feedback Scope
*
Specific configuration
General setup
Not sure
Configuration Feedback
Overall satisfaction with the configuration
*
1
2
3
4
5
Evaluation of configuration aspects
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Usability
1
2
3
4
5
Workflow efficiency
6
7
8
9
10
Clarity of settings
11
12
13
14
15
Staff coordination
16
17
18
19
20
Main configuration issue or improvement requested
*
Overall impact on daily operations
Please Select
Very positive
Positive
Neutral
Negative
Very negative
Recommendations and Follow-up
Suggested Improvements
*
Preferred Follow-up
*
Please Select
Email
Phone Extension
Department Meeting
No Follow-up Needed
Submit
Should be Empty: