Patient Name:                                                                                      
Admission Date:                                                                                      
Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.
Thank you for your time
How satisfied were you with each of the following aspects during your stay with us?
Excellent Very Good Good Satisfactory Poor
1. Admission Staff welcoming and helpful?
2. How well was the waiting time managed?
3. Cleanliness of hospital and patient's room?
4. Nursing staff treat patients with courtesy and respect?
5. Nurses explain things in a way the patient can understand?
6. How well physicians communicate and treat the patients?
7. Received well prepared, warm and covered food?
8. How well hospital hospital staff help patients manage pain?
9. Discharge information well communicated and assistance offered?
10. Patient's overall rating of the hospital: Would you recommend the hospital to a friend or family member?
Remarks and Suggestions
Thank you for your valuable input
MooiMed Private Hospital
Your medical well-being is our priority