Sample Patient Satisfaction Questionnaire

Patient satisfaction questionnaire is like asking question if the patient is really satisfied with doctors or health care centers. This questionnaire is used to show utilitarianism. Patient satisfaction questionnaire is provided to patience before he is about to discharge from hospital. It the questions involved would be related to his likes and dislikes he had with the total treatment from the hospital.

Then most important point in proving a Patient satisfaction questionnaire is to easily discover the facts and make essential changes in treating the patience’s. Patient satisfaction questionnaire is almost implemented in every country but to a very less extent in Asian countries. Both government and private hospitals should make a habit of preparing Patient satisfaction questionnaire.

According the latest survey the old patients were willing to take this questionnaire then the younger ones. When comparing to men and women, women showed keen interest in answering the Patient satisfaction questionnaire.


Patient Satisfaction Questionnaire Sample:


  1. How you like to take the questionnaire, would you prefer phone calls, Emails or a hard copy?
  2. Name of the patient?
  3. Age and Sex?
  4. Have you been treated before or is this is the first one?
  5. Are you satisfied with the end result?
  6. Who did the nurses treat you?
  7. Did the doctor explain you every thing about the treatment?
  8. Was the doctor showing interest in your problem?
  9. Was the medication provided in time?
  10. Were you comfortable with the room and ventilation?
  11. Your likes and dislikes on the facilities?
  12. Was the doctor available in time?
  13. Are you willing to see your X-ray?
  14. Are you satisfied with the Payment plans?
  15. How long you had to wait in the waiting room?
  16. Was the staff willing to help you?
  17. Do you require many more centers or branches of the same hospital near by?
  18. How quickly was your call scheduled?
  19. Was the receptionist polite?
   20.Would you recommend this health center to your friends and family members?