Hospital discharge planning feedback evaluation form template helps healthcare providers and administrators collect patient and family caregiver perspectives on the discharge experience to improve care transitions, safety, and satisfaction.

This free template includes customizable fields for patient name and discharge date, plus Likert-scale (1–5) items assessing overall satisfaction, clarity of discharge instructions, timeliness of the process, and communication with the healthcare team.

It also contains an open-ended section for additional comments or suggestions and supports anonymous submissions to encourage candid feedback. Deploy the form in hospitals, post-acute settings, home-health programs, or outpatient follow-up clinics to monitor performance, identify gaps, and guide targeted quality improvement projects.

Customize questions, apply conditional logic, and connect results to your workflow or EHR for efficient review and reporting using your free template in SurveyMars's builder. Click "Use This Template" to personalize securely and deploy the form quickly and start collecting actionable patient feedback right away.