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  • HD Hospital Covid 19 Vaccination Survey

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    Shailendra Pandav
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    This document is a survey from a hospital seeking feedback from patients who received the Covid19 vaccine. It collects demographic information like sex, age, and dose number. It then asks patients to rate their overall satisfaction, waiting period, ease of vaccination, staff behavior, environment, and level of discomfort on a scale from very satisfied to very unsatisfied. It concludes by thanking the patient for their time and says their responses will help improve the vaccination process.

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    This document is a survey from a hospital seeking feedback from patients who received the Covid19 vaccine. It collects demographic information like sex, age, and dose number. It then asks patients to rate their overall satisfaction, waiting period, ease of vaccination, staff behavior, environment, and level of discomfort on a scale from very satisfied to very unsatisfied. It concludes by thanking the patient for their time and says their responses will help improve the vaccination process.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    1 views2 pages

    HD Hospital Covid 19 Vaccination Survey

    Uploaded by

    Shailendra Pandav
    This document is a survey from a hospital seeking feedback from patients who received the Covid19 vaccine. It collects demographic information like sex, age, and dose number. It then asks patients to rate their overall satisfaction, waiting period, ease of vaccination, staff behavior, environment, and level of discomfort on a scale from very satisfied to very unsatisfied. It concludes by thanking the patient for their time and says their responses will help improve the vaccination process.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    Covid19 Vaccine Survey

    [Hospital LOGO]
    [Hospital Contact]

    We would like to have your few minutes to answer the questions below. Your responses will
    remain confidential.

    Date: ______________ Form No: _______________

    Sex: ___________________________

    Age: _____________________________

    Dose No: ____________________________

    Please rate us by ticking the boxes below:

    Very satisfied Satisfied Unsatisfied Very unsatisfied

    Overall satisfaction

    Waiting period

    Ease of Vaccination

    Staff Behaviour

    Environment

    Discomfort
    Please add any further comments / suggestions for us:

    _________________________________________________________________________

    Patient Name:

    ________________________________

    Signature:

    ________________________________

    Date:

    ________________________________

    Thank you for sparing your precious time and responding to the survey. Your response will
    help us ensure a better working at every point.

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