Patient Engagement Survey
Please take a few minutes to complete this survey about your experience as a patient. Your feedback is important to us.
Name
First Name
Last Name
1. How would you rate your overall experience as a patient?
1
2
3
4
5
2. How satisfied are you with the quality of care you received?
1
2
3
4
5
3. Did healthcare providers communicate effectively and listen to your concerns?
Yes
No
Not applicable
4. Were you involved in the decision-making process regarding your treatment?
Yes
No
Not applicable
5. Did you feel respected and valued as a patient?
Yes
No
Not applicable
6. How would you rate the accessibility of healthcare services?
1
2
3
4
5
7. Did you receive timely and appropriate follow-up care?
Yes
No
Not applicable
8. Would you recommend our healthcare clinic to others?
Definitely
Maybe
Not at all
9. What can we do to improve our services?
Submit
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