QuestionPro's LiveChat
Onboarding Expert
Thanks for visiting. If you have any questions as you click around, I'm available here to answer them.
| Sales:  +1 (800) 531-0228  |  Live Chat  |  Login »

Survey Template Library

 
Survey Name Health Care Opinion Survey
Description Hospital and health care opinion survey.
Category Health Care   (Browse All Categories)

Create a free account and customize this survey


Join Now!
It's completely Free!
 

   

This is the questionnaire that deals with health care and your involvement in health care. Please take a few minutes to express your opinions about the availability and quality of health care in your community. Your answers are important to the success of this study.



Thank you for your assistance.
 
   

Which community (or rural area) do you live?
 
 
   

Is there a wide difference in performance between the available hospitals in this area?
 
   

Do you have a favorite hospital?
 
   

Is there a wide difference in the cost of the different hospitals in this area?
 
   

Do you receive considerable amount of pressure from other family members to get health care problems taken care of promptly?
 
   

Do you feel comfortable judging the differences between hospitals in this area?
 
   

Do you generally receive care from the same hospital?
 
   

Can you be helpful to friends who are having difficulty making section of a hospital?
 
   

How many years have you lived in this community?
 
 
   

How satisfied are you with the skill and competency of the staff?
 
   

Does the hospital have equipment for modern diagnosis and treatment?
 
   

Does the hospital have modern operating room facilities?
 
   

How satisfied are you with the following:
Overall cleanliness of the hospital
 
   

Efficiency of nursing care
 
   

Friendliness and courtesy of the staff
 
   

Convenience of location for you
 
   

Cost to you
 
   
 
What kind of medical insurance coverage do you have?
 
   
 
How many times have you and any member of your family been to your doctor in the last year?
 
 
   
 
How many times have you visited a friend or loved one in the hospital in the last year?
 
 
   
 
How many times have you and other members of your family been a patient in a hospital in the last 3 years?
 
 
   
 
Which source of care would you prefer if you had a personal injury that could be handled equally well by each of these sources of health care:
 
   
 
If you or a member of your family have received medical care at another hospital while living in the [HOSPITAL] area, why did you choose the other hospital?
 
   
 
When making health care decisions for your family, who is the primary decision maker?
 
   
 
From your experience in the past, when you or a member of your family needs hospital care, who decides on the hospital?
 
   
 
What have you heard about the care patients receive at [Hospital]?
 
 
   
 
The last section of the questionnaire contains a series of questions about your demographic characteristics such as age and income. We are asking these questions in order to determine if various groups have different opinions and attitudes about hospital care. Please answer these personal questions. No one will ever associate these responses with your name.
 
   
 
Sex of person completing this questionnaire:
 
   
 
Age of person completing this questionnaire:
 
 
   
 
Age(s) of children living in your household: (Check all that apply)
 
   
 
Marital status of person completing this questionnaire:
 
   
 
What was your total household income (from all sources) before taxes for the year [Year]?
 
   
 
Please indicate the highest level of formal education that you have completed.
 
   
 
What is your primary occupation?
 
 
   
 
What is your spouse's primary occupation?
 
 
   
 
Thank you for your assistance.
 


Create a free account and customize this survey


Join Now!
It's completely Free!
 



© QuestionPro Online Survey Software | 800-531-0228
QuestionPro Inc, Market Survey Companies, Seattle, WA