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Patient Satisfaction Evaluation from Hospitalized Patients

Dear visitor, this questionnaire is fully confidential and is designed to improve the quality of provided services. Therefore, please carefully answer the questions.

If you have not received a certain service or have no contacts with one of the units, please select the “No Opinion” option.

code: IS/FO/PR/00-00/1-1

Revision Date: June 22, 2022

Next Revision Date: June 22, 2023

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1. Name & Surname (Optional)

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2. Gender (Please select only one option)

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3. Age (Please select only one option)

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4. Education (Please select only one option)

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5. Hospitalization ward (Please select only one option)

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6. Total hospitalization days (please enter a single number): 

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7. Name of the attending physician: 

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8. The questionnaire is filled by (Please select only one option):

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9. What is your level of satisfaction regarding the behavior and actions of your physician? (Please select only one option):

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10. What is your level of satisfaction regarding the physician’s answer to your questions and education provided by the physician? (Please select only one option):

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11. What is your level of satisfaction regarding accessibility of your physician (Please select only one option):

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12. What is your level of satisfaction regarding the behavior and actions of the nurses? (Please select only one option):

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13. What is your level of satisfaction regarding the performance/speed of the nurses while providing services? (Please select only one option):

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14. What is your level of satisfaction regarding the nurses’ answer to your questions and education provided by the nursing staff? (Please select only one option):

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15. What is your level of satisfaction regarding the privacy (during examination, entering and exiting the hospitalization room, etc.) provided by the hospital staff? (Please select only one option):

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16. What is your level of satisfaction regarding the behavior and reception of the service staff and nursing assistants? (Please select only one option):

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17. What is your level of satisfaction regarding the cleaning of the ward, beds, blankets, toilets, etc. during your stay? (Please select only one option):

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18. What is your level of satisfaction regarding the welfare facilities in the ward and hospital (including heating and cooling, refrigerators, televisions, etc.)? (Please select only one option):

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19. What is your level of satisfaction regarding the quality of the food? (Please select only one option):

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20. What is your level of satisfaction regarding the signs and marks installed in the hospital? (Please select only one option):

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21. What is your level of satisfaction regarding constant access to spiritual facilities (prayer equipment, prayer room, Quran, etc.)? (Please select only one option):

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22. Will you recommend this hospital to other people? (Please select only one option):

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23. For Improving the quality of services, please input any criticisms or suggestions you have for the hospital staff:

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