Pediatric Hospital Patient Satisfaction Survey Form
We value your feedback. Please complete the Pediatric Hospital Patient Satisfaction Survey Form to help us improve our services.
Overall, how satisfied were you with your experience at our hospital?
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1
2
3
4
5
How would you rate the friendliness and professionalism of our staff?
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1
2
3
4
5
How clean and comfortable did you find the hospital facilities?
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1
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3
4
5
How clear and helpful was the communication from our medical team?
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1
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5
How would you rate the timeliness of your care (including wait times)?
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5
Please indicate your level of agreement with the following statements:
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Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The hospital environment was welcoming.
1
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4
5
Staff listened to my concerns.
6
7
8
9
10
Instructions for care were easy to understand.
11
12
13
14
15
Which area of the hospital did you visit?
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Please Select
Emergency Department
Inpatient Ward
Outpatient Clinic
Surgery/Procedure Area
Other
How likely are you to recommend our hospital to others?
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Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
What did you like most about your experience?
What could we improve?
Any additional comments or suggestions?
Submit Feedback
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