HEALTHCARE PATIENT SATISFACTION SURVEY CHECKLIST

Created by ChecklistGuro (https://checklistguro.com)

--- ARRIVAL & REGISTRATION ---
[ ] Arrival Time
[ ] Were you greeted promptly upon arrival? (Yes, No, Not Applicable)
[ ] How would you rate the friendliness of the front desk staff? (Excellent, Good, Fair, Poor)
[ ] Please describe any difficulties you experienced during registration.
[ ] How long did you wait to be called back from the waiting area (in minutes)?
[ ] Was the registration process clear and easy to understand? (Yes, No, Somewhat)

--- APPOINTMENT SCHEDULING ---
[ ] How easy was it to schedule your appointment? (Very Easy, Easy, Neutral, Difficult, Very Difficult)
[ ] Original Requested Appointment Date
[ ] Scheduled Appointment Date
[ ] Scheduled Appointment Time
[ ] How satisfied were you with the wait time for your appointment? (Very Satisfied, Satisfied, Neutral, Dissatisfied, Very Dissatisfied)
[ ] Please describe any difficulties you encountered when scheduling your appointment.
[ ] Was the reason for your appointment clearly understood during scheduling? (Yes, No, Not Applicable)

--- DOCTOR/PROVIDER INTERACTION ---
[ ] How would you rate your doctor’s communication skills? (Excellent, Good, Fair, Poor)
[ ] Did the doctor explain your diagnosis and treatment plan clearly? (Yes, No, Somewhat)
[ ] Please describe what the doctor did well during your visit.
[ ] What could your doctor have done to improve your experience?
[ ] Did you feel the doctor listened to your concerns? (Yes, No, Somewhat)
[ ] On a scale of 1-10 (1 being not at all, 10 being extremely), how would you rate your doctor’s empathy?

--- NURSING STAFF INTERACTION ---
[ ] How would you rate the nurses' overall friendliness and approachability? (Excellent, Good, Fair, Poor, Very Poor)
[ ] How responsive were the nurses to your needs and requests? (Very Responsive, Responsive, Neutral, Unresponsive, Very Unresponsive)
[ ] Please describe any specific examples of excellent or poor nursing care you received.
[ ] How quickly were nurses able to respond to your calls for assistance (in minutes)?
[ ] Which of the following best describe your experience with nurse communication? (Clear and easy to understand, Empathetic and supportive, Respectful of my questions, Rushed and impersonal, Did not address my concerns)
[ ] Were you comfortable asking nurses questions about your care? (Yes, very comfortable, Yes, somewhat comfortable, Neutral, No, somewhat uncomfortable, No, very uncomfortable)

--- FACILITY & ENVIRONMENT ---
[ ] Rate the cleanliness of the waiting area (1-5, 1=Very Dirty, 5=Spotless)
[ ] Rate the comfort of the waiting area seating (1-5, 1=Very Uncomfortable, 5=Very Comfortable)
[ ] How would you rate the noise level in the facility? (Too Loud, Slightly Loud, Acceptable, Quiet, Very Quiet)
[ ] Which of the following aspects of the facility could be improved? (Select all that apply) (Temperature, Lighting, Smell, Décor, Accessibility, None)
[ ] Please provide any specific comments about the facility's environment.
[ ] Was the facility easily accessible for people with disabilities? (Yes, No, Not Applicable)

--- TREATMENT & CARE ---
[ ] How satisfied were you with the treatment you received? (Very Satisfied, Satisfied, Neutral, Dissatisfied, Very Dissatisfied)
[ ] On a scale of 1-10 (1 being very low, 10 being excellent), how would you rate the effectiveness of your treatment?
[ ] Please describe your experience with the medical procedures performed.
[ ] Were you given clear explanations about your treatment plan? (Yes, No, Partially)
[ ] Were there any complications or unexpected outcomes during your treatment? Please describe.
[ ] Did you feel your concerns were adequately addressed by the medical staff? (Yes, No, Not Applicable)

--- DISCHARGE & FOLLOW-UP ---
[ ] Were discharge instructions clearly explained? (Yes, No, Somewhat)
[ ] Please describe any difficulties you encountered understanding the discharge instructions.
[ ] Date of follow-up appointment (if scheduled)
[ ] Scheduled follow-up appointment time (if applicable)
[ ] Do you know how to contact the clinic/hospital with questions after discharge? (Yes, No, Unsure)
[ ] Any other comments or suggestions regarding your discharge process?
[ ] Were you given contact information for support services (e.g., home health, social work)? (Yes, No, Not applicable)

--- BILLING & INSURANCE ---
[ ] Were billing statements easy to understand? (Yes, No, Not Applicable)
[ ] Estimate of your total bill amount:
[ ] Insurance provider:
[ ] Were your insurance benefits explained clearly? (Yes, No, Not Applicable)
[ ] Please describe any issues you encountered with billing or insurance:
[ ] Did you receive a timely response to your billing inquiries? (Yes, No, Not Applicable)

--- OVERALL EXPERIENCE ---
[ ] Overall Satisfaction (1-10)
[ ] Would you recommend our facility to others? (Yes, No, Maybe)
[ ] What did you like most about your visit?
[ ] What could we have done to improve your experience?
[ ] How likely are you to return to our facility? (Very Likely, Likely, Neutral, Unlikely, Very Unlikely)
[ ] Optional: Upload any supporting documentation (e.g., photos)

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