Hospital Patient Survey
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1.- Participate In Our Survey
Please take a moment to complete this brief survey. The information you provide will be very helpful for [HOSPITAL]. Your answers will be kept confidential and will not be used for any purpose other than this study conducted by [HOSPITAL]. This survey will take about 5 minutes to complete.
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 on this hospital
My insurance recommended it
It was my choice
I was brought to the emergency room
Other (please specify)
3.
What is the speciality of your referring doctor?
General medecine
Pediatrics
Gynecology
Othorhinolaryngology
General surgery
Neurosurgery
Urology
Orthopedics
Oncology
Others (please specify)
4.
How long were you in the hospital?
1 to 3 days
4 to 6 days
7 days or more
5.
In which unit did you stay?
Maternity
General
Surgery
ICU
Rehabilitation
Pediatrics
Trauma
Other (please specify)
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