Hospital Discharge Planning Feedback Evaluation Form Template

We value your feedback on the hospital discharge planning process. Please tell us about your experience so we can improve our services.
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1.
Patient's Full Name
2.
Date of Discharge
3.
How would you rate your overall satisfaction with the discharge planning?
Very dissatisfied
Very satisfied
4.
How clear were the discharge instructions you received?
Very unclear
Very clear
5.
How would you rate the timeliness of the discharge process?
Very late
Very timely
6.
How would you rate communication with the healthcare team during discharge?
Very poor
Excellent
7.
Any additional comments or suggestions?
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