INPATIENT SATISFACTION FORM OUTPATIENT SATISFACTION FORM Person Completing the Survey: PatientRelative Gender: FemaleMale Nationality: TRNCTRTRNC & TROther Social security: SGKPrivate Health InsuranceNone Did you receive services from our hospital for the first time? YesNo Name and surname of your doctor in our hospital: DOCTORS (Multiple Choice - 5 best / 1 worst) 1.My doctor has given me enough of his/her time. 12345 2.My doctor gave me enough information about the diagnosis and treatment. 12345 3.My doctor was interested and kind to me. 12345 4.My doctor gave me confidence. 12345 NURSING AND PATIENT CARE SERVICES (Multiple Choice - 5 best / 1 worst) 1.The nurses responded to my calls in a timely manner 12345 2.The nurses were attentive and kind to me. 12345 3.The nurses were knowledgeable and professional. 12345 4.The caregiver was interested and polite. 12345 HOSPITAL AND ROOM CLEANING (Multiple Choice - 5 best / 1 bad) 1.The room was clean and tidy. 12345 2.Room temperature/ventilation was appropriate. 12345 3.The room had personal cleaning supplies (toilet paper, towels, etc.) and furnishings that I might need. 12345 4.Sufficient information was given about room equipment. 12345 PRICE AND ADMISSION-DISCHARGE SERVICES (Multiple Choice - 5 best / 1 worst) 1.Information regarding prices and payment terms was sufficient. 12345 2.I had no problems during the patient admission procedure. 12345 3.For my discharge, my procedures were completed in a short time and without any problems. 12345 4.Staff involved in the discharge procedure were polite and attentive. 12345 GENERAL EVALUATION 1.In general, how satisfied are you with the services you received from NEU Hospital? (Very satisfied / Satisfied / Undecided / Unsatisfied / Not at all satisfied) Very satisfiedSatisfiedUndecidedUnsatisfiedNot at all satisfied 2.Would you come to NEU Hospital again? YesNoUndecided 3.Would you recommend NEU Hospital to your relatives? YesNoUndecided 4.Would you prefer your doctor again? YesNoUndecided 5.Would you recommend your doctor to your relatives? YesNoUndecided Please share the reasons for the questions you answered "No / Undecided". Please fill out our survey to help us assess the quality of the services you have received from our hospital and to offer you better quality services in the future. Person completing the survey: PatientRelative of a Patient Gender: FemaleMale Nationality: TRNCTRTRNC&TROther Social Security: SGKPrivate Health InsuranceNone Is this your first time receiving services from our hospital? YesNo Name and surname of your physician in our hospital? EVALUATION OF SERVICES Please state the level of your agreement with the following sentences. Choose 5 if you strongly agree, 4 if you agree, 3 if you are neutral, 2 if you don't agree, 1 if you don't agree at all. 1.I could easily reach the hospital call centre. 54321 2.Call centre officials properly informed and directed me. 54321 3.It was easy for me to make an appointment. 54321 4.Patient Advisors / Receptionists welcomed me with a smile. 54321 5.Staff were polite and courteous in general. 54321 6.My registration / acceptance process was completed on time. 54321 7.My billing / payment transactions were performed smoothly. 54321 8.Information was given about the waiting time for the examination. 54321 9.The waiting areas were comfortable. 54321 10.I was received on time. 54321 11.The nurse was kind and attentive. 54321 12.My doctor gave me adequate information about the diagnosis and treatment. 54321 13.My doctor gave me confidence. 54321 14.Tests and examinations were performed on time. 54321 15.The prices were affordable considering the services I have received. 54321 16.The department where I received services was hygienic and clean. 54321 17.The toilets are clean. 54321 GENERAL EVALUATION Please indicate your satisfaction with the following statements. Choose 5 for Very Satisfied, 4 Satisfied, 3 for Neutral, 2 for Unsatisfied, 1 for Not Satisfied at all. 1.I easily reached my destination using the directional signs inside the building. 54321 2.In general, to what extent are you satisfied with the service you received from our hospital? 54321 3.How satisfied are you with the cafeteria services? 54321 4.How satisfied are you with the overall cleanliness of our hospital? 54321 Please provide the most appropriate answer to the following questions. If your answer is No, please state the reason. 1.Would you come back to our hospital again? YesNo 2.Would you recommend our hospital to your relatives? YesNo 3.Would you prefer the same physician? YesNo 4.Would you recommend the physician to your relatives? YesNo Additional Comments: