Outpatient (emergency) patient satisfaction questionnaire

Hello, comrade, welcome to our hospital for treatment. Please evaluate the service of the medical staff you contact according to your personal experience. We will further improve our work according to your assessment and create a "three good and one satisfied" medical environment with "good service, good quality, good medical ethics and satisfaction of the masses".

Thank you for your cooperation!

Department where you see a doctor:

1. Your waiting time for outpatient (emergency) treatment.

□ 10 minutes or less □ 10 ~ 29 minutes □ 30 ~ 59 minutes □ 1 hour ~ 2 hours □2 hours or more.

2. How do you feel about the service attitude of outpatient (emergency) doctors?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

3. When you ask the outpatient (emergency) doctor, can you answer patiently?

□ Yes □ General □ No.

4. Can I see a doctor in the order of registration?

□ Yes □ General □ No.

5. Can your registered doctor make house calls on time?

□ Yes □ General □ No.

6. When seeing a doctor, can the doctor be patient and meticulous?

□ Yes □ General □ No.

7. How do you feel about the doctor's diagnosis and treatment technology?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

8. Do you think doctors prescribe too many prescriptions?

□ Yes □ Maybe □ No.

9. Do you feel that the doctor is over-examining?

□ Yes □ Maybe □ No.

10. Have you ever encountered the phenomenon that medical staff collect cash privately during medical treatment?

□ Yes (amount: RMB) □ No toll station.

1. Waiting time in line when paying hospitalization expenses.

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. What do you think is the queue order of payment in our hospital?

□ Orderly □ General □ Disorder

What do you think of the service attitude of the toll booth staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. What do you think of the service efficiency (speed of handling business) of the staff in the toll room?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

When you ask the toll booth staff, can you answer patiently?

□ Yes □ General □ No 1. Your waiting time at the pharmacy

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. Your queuing order at the pharmacy (pharmacy)

□ Orderly □ General □ Disorder

3. What do you think of the service attitude of pharmacy staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. How do you feel about the service efficiency (speed of handling business) of pharmacy staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

When you ask the staff of pharmacy, can you answer patiently?

□ Yes □ General □ No 1. How long do you wait in line in the lab for the test?

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. You test the queue order in the laboratory.

□ Orderly □ General □ Disorder

3. What do you think of the service attitude of the laboratory staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. What do you think of the service efficiency (business speed) of the laboratory staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

When you ask questions about laboratory staff, can you answer them patiently?

□ Yes □ General □ No 1. How long does the radiology department (X-ray film, fluoroscopy) wait in line?

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. The order of your queue in the radiology department (X-ray, fluoroscopy)

□ Orderly □ General □ Disorder

3. How do you feel about the service attitude of the staff in radiology department (X-ray and fluoroscopy)?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. Are you satisfied, basically satisfied or generally dissatisfied with the service efficiency (speed of handling business) of the staff in radiology department (X-ray film and fluoroscopy)?

When you ask the staff of radiology department (X-ray and fluoroscopy), can you answer patiently?

□ Yes □ General □ No 1. Your waiting time in functional departments (B-ultrasound, color ultrasound, electrocardiogram).

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. Your queue order in functional departments (B-ultrasound, color ultrasound, electrocardiogram).

□ Orderly □ General □ Disorder

3. How do you feel about the service attitude of the staff in functional departments (B-ultrasound, color ultrasound and electrocardiogram)?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. How do you feel about the service efficiency (business speed) of the staff in functional departments (B-ultrasound, color ultrasound and electrocardiogram)?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

5. When you ask the staff of functional departments (B-ultrasound, color ultrasound, electrocardiogram) whether they can patiently answer □ Yes □ General □ No 1. How long did you wait in line in the operating room?

□ Within 5 minutes □5 ~ 9 minutes □ 10 ~ 19 minutes □ 20 ~ 29 minutes □30 minutes or more.

2. The order of your queue in the operating room

□ Orderly □ General □ Disorder

3. What do you think of the service attitude of the operating room staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

4. How do you feel about the service efficiency (business speed) of operating room staff?

□ Satisfied □ Basically satisfied □ Generally dissatisfied.

When you ask the operating room staff, can you answer patiently?

□ Yes □ General □No. If you have any complaints or suggestions, please briefly describe them in words.

Signature:

date month year