Hospital patients survey
1.- Take place in our survey
Please take a moment to complete this brief survey. Provided information will be very useful for [HOSPITAL].
Your answers will be treated confidentialy and we shall not be used for any purpose other than research taked by [HOSPITAL].
This survey will take about 5 minutes to complete it.
1.
Is this your first time as a patient in [HOSPITAL]?
Yes
No
2.
Why did you choose [HOSPITAL]?
My doctor recommended it
My doctor insisted in this hospital
My insurance recommended it
It was my election
I came directlly through emergency
Others (Please specify)
3.
What is the doctor that sent you to this hospital speciality?
General medicine
Pediatrics
Gynecology
Othorhinolaryngology
General surgery
Neurosurgery
Urology
Orthopedics
Oncology
Others (Please specify)
4.
How many days were you in hospital?
From 1 to 3 days
From 4 to 6 days
7 days or more
5.
In which unit did you stay?
Maternity
General
Surgery
UVI
Rehabilitation
Pediatrics
Traumatology
Others (Please specify)
Pag. 1 / 3
This survey has been launched using the online survey software found at www.encuestafacil.com.
The no. 1 web survey tool in Europe and Latin America. You too can gather information quickly and easily by conducting your own FREE online surveys at encuestafacil.com.
Encuestafacil.com is not responsible for the content sent and/or included in a survey.