Visitor satisfaction questionnaire template

Dear Sir or Madam,

By filling out this survey, you help us improve visitor/patient experience and increase quality of provided services.

We truly appreciate your insight and your time.

Important: This survey is completely anonymous.

1. What is your overall satisfaction with [name of your medical facility]?

(1 star = minimum satisfaction / 5 stars = maximum satisfaction)

2. When was your last visit to [name of your medical facility]?

Select one answer

  • Today
  • Few days ago
  • Few weeks ago
  • More than one month ago

3. Which unit did you visit?

Select one answer

  • [Unit 1]
  • [Unit 2]
  • [Unit 3]

4. How would you rate the individual aspects of the facility?

Select one answer in each row

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Cleanliness

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Comfort

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Privacy

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Safety

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Room amenities

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

Food services

  • Excellent
  • Good
  • Fair
  • Poor
  • Can't tell

5. How would you rate the communication with the attending physician?

  • -2
  • -1
  • 0
  • 1
  • 2

Confusing

Clear

  • -2
  • -1
  • 0
  • 1
  • 2

Dishonest

Honest

  • -2
  • -1
  • 0
  • 1
  • 2

Indifferent

Compassionate

  • -2
  • -1
  • 0
  • 1
  • 2

Vague

Detailed

  • -2
  • -1
  • 0
  • 1
  • 2

Disrespectful

Respectful

  • -2
  • -1
  • 0
  • 1
  • 2

Alarming

Reassuring

  • -2
  • -1
  • 0
  • 1
  • 2

One-sided

Interactive

6. Have you ever received conflicting information from different medical staff members?

Select one answer

  • No, I always received consistent information.
  • Yes, but it was a rather rare experience.
  • Yes, this happened on multiple occasions.

7. How much do you agree with the following statements?

Select one answer in each row

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The facility creates a welcoming and calm environment.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The facility's infrastructure ensures easy accessibility and hassle-free parking.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The facility uses state-of-the-art medical equipment.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The facility canteen offers a wide selection of food and beverages.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

Waiting rooms and public areas offer a sufficient amount of seating and space.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

Visiting hours at this facility suit my needs well.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

The facility's information system provides clear and useful information.

  • Definitely agree
  • Rather agree
  • Rather disagree
  • Definitely disagree
  • Can't tell

8. How easy was it for you to find your way around the facility?

Select one answer

  • Choose...
    • Choose...
    • Very easy
    • Rather easy
    • Rather difficult
    • Very difficult

9. How likely are you to recommend [name of your medical facility] to your friends and relatives?

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Not at all likely

Extremely likely

10. Do you have any other suggestions for improving our services?

500

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Survey Templates Healthcare

Visitor satisfaction survey

Popularity 13 ×

Gain insightful feedback with our visitor satisfaction questionnaire template, tapping into the unique perspectives of visitors coming to see patients in your institution.

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The survey sample is ideal for

  • managers of hospital departments,
  • senior management,
  • directors of private medical centers and clinics.

Our visitor satisfaction questionnaire template is specifically designed to capture the often-overlooked feedback, which can still provide valuable insights into their experiences with your facility. Using this tailored questionnaire will aid in identifying strengths and areas for improvement, ensuring a welcoming and positive environment for everyone who comes through your doors.

Understand the impact of healthcare surveys on your success and profitability.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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