Free Patient Satisfaction Evaluation Checklist Template
Patient Satisfaction Evaluation Checklist
1. Appointment Process
Task |
Completed (✓) |
---|---|
Ease of scheduling appointments. |
|
Timeliness of appointment confirmation. |
|
Availability of preferred dates and times. |
|
Efficient check-in process upon arrival. |
|
2. Facility Environment
Task |
Completed (✓) |
---|---|
Cleanliness of waiting and examination areas. |
|
Comfort and accessibility of seating and amenities. |
|
Availability of parking or public transport options. |
|
Clear signage and directions within the facility. |
|
3. Staff Interaction
Task |
Completed (✓) |
---|---|
Friendliness and professionalism of front desk staff. |
|
Courteousness and empathy were shown by the medical staff. |
|
Effective communication during interactions. |
|
Respect for patient privacy and confidentiality. |
|
4. Consultation Experience
Task |
Completed (✓) |
---|---|
Time spent by the provider to explain the diagnosis and treatment. |
|
Provider’s ability to answer patient questions thoroughly. |
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Perception of provider’s knowledge and expertise. |
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Clear communication of follow-up care instructions. |
|
5. Treatment and Outcomes
Task |
Completed (✓) |
---|---|
Satisfaction with the effectiveness of the treatment. |
|
Minimal waiting times for procedures or treatments. |
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Adequate pain management or comfort measures. |
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Accessibility of prescribed medications or resources. |
|
6. Feedback and Follow-Up
Task |
Completed (✓) |
---|---|
Opportunity to provide feedback on the experience. |
|
Timeliness and effectiveness of follow-up appointments. |
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Resolution of concerns or issues raised by the patient. |
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Overall satisfaction with the care received. |
|
Overall Patient Satisfaction Rating:
-
Excellent
-
Satisfactory
-
Needs Improvement
-
Poor
Additional Comments:
[Insert any additional feedback, observations, or suggestions for improvement.]
Evaluator Name: [Your Name]
[Date Signed]
Patient Name: [Patient Name]
[Date Signed]