Healthcare Assessment Survey Template

Improve healthcare services using crucial patient insights to make informed decisions using this customizable Healthcare Assessment Survey Template.

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This survey covers various aspects of healthcare, including health status, lifestyle, healthcare services, and health insurance. By gathering patient insights, healthcare organizations can identify areas for improvement and enhance the quality of care they provide to patients.

22 Questions

24Screens

3 mins to complete

Healthcare Assessment Survey Template Questions

The following questions are included in this Healthcare Assessment Survey Template.

1. How old are you?
2. What is your gender?
3. What is your ethnic background?
4. What is your employment status?
5. How would you rate your overall physical health?
6. How would you rate your overall mental/emotional health?
7. How would you rate your stress levels?
8. Do you have any chronic health conditions?
9. Please specify your chronic health conditions.
10. Do you have any hereditary conditions/diseases?
11. Please specify your hereditary conditions/diseases
12. Do you smoke or use tobacco products?
13. How often do you consume alcohol?
14. How would you rate your level of physical activity?
15. How many hours of sleep do you typically get per night?
16. Do you have any allergies
17. How often do you visit your primary care physician?
18. Have you ever been admitted to the hospital?
19. Please specify your reason for hospitalization
20. Do you have health insurance?
21. If you do not have health insurance, why not?
22. Please share any additional comments or concerns regarding your health

Healthcare Assessment Survey Template FAQ

1. What is a healthcare assessment survey template?
A healthcare assessment survey template is a pre-designed questionnaire that helps hospitals, clinics, and healthcare centers gather important information about patients' health, medical history, lifestyle, and healthcare experiences. It enables healthcare providers to assess patients' needs, improve care quality, and enhance patient outcomes.
2. How can my healthcare center benefit from using a healthcare assessment survey template?
Using a healthcare assessment survey template provides several benefits. It allows you to gather comprehensive information about patients, make more informed decisions regarding their treatment, identify areas for improvement in healthcare services, and enhance overall patient satisfaction.
3. Can the healthcare assessment survey template be customized to meet the specific needs of my hospital/clinic/healthcare center?
Yes, the healthcare assessment survey template offered by Zonka Feedback can be customized according to the specific requirements of your hospital, clinic, or healthcare center. You can modify the questions, add or remove sections, and tailor the survey to gather the information that is most relevant to your organization.
4. Can patients complete the healthcare assessment survey online or in-person?
The healthcare assessment survey can be designed to accommodate both online and in-person completion. You can provide patients with the option to complete the survey virtually by sending them the survey via SMS, email, website, in-app, and embed link or provide printed copies of the survey to be filled out during their visit.

Create and send this Healthcare Assessment Survey Template