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