Hospital Oral Care Survey Form
Please share your feedback to help us improve oral care services during your hospital stay.
Overall, how satisfied were you with the oral care provided during your hospital stay?
*
1
2
3
4
5
How would you rate the professionalism of the staff providing oral care?
*
1
2
3
4
5
How clearly were the oral care instructions explained to you?
*
Not clear at all
1
2
3
4
Extremely clear
5
1 is Not clear at all, 5 is Extremely clear
How comfortable did you feel during your oral care procedures?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Did you feel your pain was managed appropriately during oral care?
*
Yes
No
Not applicable
How clean did you perceive the oral care environment and tools to be?
*
Not clean
1
2
3
4
Very clean
5
1 is Not clean, 5 is Very clean
How likely are you to recommend our hospital's oral care services to others?
*
Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
What was the main reason for your oral care visit during your hospital stay?
Please Select
Routine hygiene
Treatment of oral discomfort
Pre-surgery preparation
Other
Please share any additional comments or suggestions about your oral care experience.
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