Renal Dialysis Unit
Patient Satisfaction Survey
A. Patient Information
Age
*
Gender
*
Select Gender
Male
Female
Other
Prefer not to say
Duration of Dialysis Treatment
*
Select Duration
Less than 6 months
6 months - 1 year
1 - 3 years
3 - 5 years
More than 5 years
B. Satisfaction Rating
Please rate the following services using the scale:
1
Poor
2
Needs Improvement
3
Satisfactory
4
Very Satisfactory
5
Excellent
1. Facility & Environment
Cleanliness of the dialysis unit
1
2
3
4
5
Comfort of the dialysis chairs/bed
1
2
3
4
5
Overall environment (quiet, safe, orderly)
1
2
3
4
5
2. Staff Performance
Courtesy and respect from nurses
1
2
3
4
5
Courtesy and respect from technicians
1
2
3
4
5
Courtesy and respect from doctors
1
2
3
4
5
Staff responsiveness to needs
1
2
3
4
5
Skill and competence of dialysis staff
1
2
3
4
5
3. Dialysis Treatment & Services
Waiting time before treatment
1
2
3
4
5
Monitoring during dialysis
1
2
3
4
5
Availability of doctors when needed
1
2
3
4
5
C. Suggestions
Please provide any suggestions or comments to help us improve our services:
Submit Your Feedback
View Survey Results (Admin)