Hospital Performance Evaluation Template Survey

NOTE: If the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) applies to you and your intended use of SurveyMonkey, this template is NOT intended for your use without 1) a SurveyMonkey ‘HIPAA-enabled’ account, and 2) a business associate agreement with us, which can be purchased by contacting our sales team. Please see our Acceptable Uses Policy for more information.

1.How knowledgeable was the staff at this hospital?

2.How professionally did the staff at this hospital behave?

3.How easy was it to talk to the staff at this hospital about your medical condition(s)?

4.How often did you receive conflicting information from the staff at this hospital?

5.How responsive was the staff at this hospital to your questions?

6.How considerate of you were the staff at this hospital?

7.How often did the staff at this hospital describe possible side effects before administering your medicine?

8.How often did the staff at this hospital explain the purpose of your medicine before administering it to you?

9.During this stay at this hospital, when you pressed the call button, how often did a staff member attend you promptly?

13.During this stay at this hospital, how often did doctors explain things in a way you could understand?

14.During this stay at this hospital, how respectfully did the doctors treat you?

16.During this stay at this hospital, how often did you feel confused about what was going on?

19.How respectful of your religious beliefs were the staff at this hospital?

20.Over the course of your stay at this hospital, were you satisfied with the care you received dissatisfied with the care you received, or neither satisfied nor dissatisfied with it?

21.How likely are you to choose this hospital for your care again in the future?