Hospital Services example
This is an example Hospital Services survey. This survey includes questions like:
How long have you been using the services of this hospital?
How satisfied are you with the surgical nurses?
General Nursing Staff?
We hope this will help you create your own Hospital Services survey. We
have not tested the validitiy or reliability of this survey. However, you may
use this as a starting point to help your own survey instrument. Feel free to
change and edit any of our survey templates to help you get started.
1) How long have you been using the services of this hospital?
Select one...
Less than 1 Year
1-2 Years
3-4 Years
5-6 Years
7-8 Years
9-10 Years
More than 10 Years
Please tell us how satisfied you are with each of the following.
2) How satisfied are you with the surgical nurses?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
3) General Nursing Staff?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
4) Laboratory Services?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
5) Patient rooms?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
6) Cleanliness of the doctor's prep rooms?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
7) Availability of surgical suites?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
8) Cleanliness of the surgical suites?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
9) Out-Patient testing facilities?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
10) Radiology facilities?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
11) Overall, how satisfied are you with the technology available at this hospital?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
12) Overall, how satisfied are you with the services provided at this hospital?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
13) Overall, how satisfied are you with the facilities provided by this hospital?
Select one...
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
14) What, if anything, can we do to improve hospital services or facilities?
15) Would you recommend this hospital to other practicing physicians?
Select one...
No
Yes