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SACHK
Quality Assurance
3
Welcome Admin
Patient Satisfaction Survey
Patient Satisfaction Survey Questionnaire
Section 1 General Information
1. Age group
Under 15
18 to 30
31 to 50
51 to 70
71 plus
2. Gender
Male
Female
3. Type of visit
Outpatient
Inpatient
Emergency
Other
Section 2 Appointment and Access
4. How easy was it to schedule your appointment
Very easy
Easy
Neutral
Difficult
Very difficult
5. How reasonable was the waiting time
Very reasonable
Reasonable
Neutral
Long
Very long
Section 3 Staff Interaction
6. How courteous were the reception staff
Excellent
Good
Fair
Poor
7. Did staff listen to your concerns
Excellent
Good
Fair
Poor
8. Were you involved in care decisions
Always
Often
Sometimes
Rarely
Never
Section 7 Open Feedback
15. What did you like most
16. What needs improvement
Submit Questionnaire
