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COVID 19 Assessment Survey Template

Before taking in patients for a check-up, use our COVID 19 Assessment Survey Template to know their condition, symptoms, and travel history. This helps you to save your time and speed up the process of care & treatment of patients.

Importance of Patient Satisfaction during the COVID19 Pandemic

According to the researchers, the coronavirus strain that emerged in Spain in June has now spread across Europe and now makes up a large proportion of infections in several countries. In this Pandemic, healthcare organizations and hospitals are working diligently to minimize the outbreak of the COVID-19. They constantly examine their patients either through a phone call or video conferencing and striving to deliver the best care and treatment along with a great patient experience.

Here, we at Zonka Feedback come up with the COVID 19 Assessment Survey Template that helps hospitals and health systems to deal with a massive influx of COVID patients efficiently with utmost care. If you are a caregiver, then you can use our COVID 19 Assessment Survey Template to capture all pre-required essential data like condition, symptoms, and travel history.

Besides collecting all the crucial data, COVID 19 Assessment Survey helps you to identify and evaluate the specific needs or health status of an individual or a large number of population. Consequently, this practice helps healthcare organizations to quickly identify the gaps in patient care and fill them to keep their patients happy and satisfied.

You can set up Patient Surveys on Email, SMS, or Tablets to administer short COVID 19 Assessment Surveys to ask patients questions about their condition, symptoms, and travel history. Based on the responses, you can quickly diagnose the symptoms of acute Coronavirus and ultimately provide quick and accurate treatment and care.     

You can connect your Hospital and Patient Management Tools to the Patient Feedback Software to automate the trigger of COVID 19 Assessment Surveys as well as to pass data like Patient Name, Patient ID, the Doctor or Physician they met, and so on. This will ensure your patients who are already surveyed don't have to spend time entering details again as you already have. 

To create a survey using the COVID 19 Assessment Survey Template, just sign up or sign in to Zonka Feedback. You’ll be able to choose this Survey Template when you begin creating your feedback form or survey and customize it to your preference.

List of COVID 19 Assessment Survey Questions

The following elementary questions can be a part of a COVID 19 Assessment Survey that can help you to analyze the seriousness of patients' conditions based on their symptoms and travel history before conducting the COVID 19 test:

Are you experiencing any of the following symptoms? Please tick the relevant one:

  • Difficulty Breathing (e.g. unable to finish sentences because of your breathing 

  • Chest Pain 

  • Having a very hard time waking up

  • Fainted or lost consciousness

  • Difficulty managing your daily life because of breathing difficulties   

Are you experiencing any of the following symptoms?

  • Fever

  • New or worsening cough   

  • Shortness of breath

  • Tiredness

  • Sore throat

  • Muscles ache

  • Loss of sense of taste

  • Loss of sense of smell

Have you been outside of the country within the last 14 days?

  • Yes

  • No   

Have you returned to your town/city from other parts of the Country within the last 14 days?

  • Yes

  • No   

In the last 14 days, have you — *

  • Been in close contact with someone confirmed to have COVID-19

  • Been in close contact with someone who is being investigated for COVID-19

  • Had lab exposure to biological material   

  • Attended a mass gathering where COVID-19 was spread

  • Lived or worked in a closed facility experiencing a COVID-19 outbreak

Sign Up for Zonka Feedback for free and implement this COVID 19 Assessment Survey Template in your account to measure patient satisfaction.

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Create and send this COVID 19 Assessment Survey with Zonka Feedback

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