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Download-Patient-Satisfaction-Template Powered By Docstoc
					A patient satisfaction template is a ready to use document which is framed in order to make a patient satisfaction
survey or questionnaire. Such templates are useful because hospitals or doctors can evaluate the satisfaction level of
their patients to know whether or not the medical services provided are up to acceptable standards or not.

Sample patient satisfaction template:

Name: _______________ [mention here the name of the patient who is filling the form]

Age: _____________ [mention here the age of the patient]

Date of birth: ___/_____/____ [Give date of birth in dd/mm/yy format]

Address: _______________ [mention here the address of the patient]

Contact number: _____________ [mention here the contact number of the patient]

Email address: __________ [mention the email address of the patient]

Name of doctor: _______________ [mention here the name of the doctor]

Name of hospital/clinic: ______________ [mention here the name of the hospital]

Medical condition of patient: ____________ [mention here the name of the patient]

Time taken for treatment: _____________ [mention here the time taken for treatment or cure]

Medical treatment provided: ____________ [mention here the main name of the medical treatment provided by

Are you satisfied with the medical treatment provided? [The question asks about the overall satisfaction]

_____________ [provide space for answer]

Do you think that your treatment took more time than required for this medical condition?

_____________________ [provide space for answer]

What do you think about the clinic condition of the doctor?

________________ [provide space for answer]

Are you satisfied with the results of the medical treatment?

________________ [provide space for answer]

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