About this template
Gather compassionate and actionable feedback from patients and their families regarding end-of-life care with this specialized Hospice Patient Satisfaction Survey. Designed specifically for medical providers, hospice facilities, and care coordinators, this template helps evaluate the quality of care, staff responsiveness, and family communication during difficult times.
Use this form to capture insights on the overall length of stay, the appropriateness of referrals, the timeliness of medical interventions, and qualitative suggestions for service improvement. By understanding the experiences of those you serve, your care team can continuously refine its approach and ensure families feel supported every step of the way.
Deploying this survey as a Google Form makes it incredibly easy to distribute digitally via email or text to families following care. With Doc2Form, you can instantly customize questions, append your organization's branding, and centralize all responses into a secure spreadsheet for continuous quality assurance and care improvement tracking.
Key features
- Evaluate overall hospice care quality and staff responsiveness
- Measure referral appropriateness and care delivery timeliness
- Collect open-ended improvement suggestions and family comments
- Track length of stay and demographic context for quality reporting
- Fully customizable to match your care facility's branding and workflow
Use cases
Post-care family satisfaction reviews for hospice and palliative centers
Quality assurance reporting for healthcare administrators and medical…
Quality assurance reporting for healthcare administrators and medical directors
Gathering qualitative feedback to improve staff training and family c…
Gathering qualitative feedback to improve staff training and family communication
What this form collects
- Full Name (Optional) (Short answer)You may leave this blank if you prefer to submit your feedback anonymously.
- Length of Stay (Dropdown)Approximately how long did you or your loved one receive care with our hospice program?
- Gender (Multiple choice)Select the option that best describes the patient.
- Referral Appropriateness Status (Multiple choice)How appropriate was the timing and transition of the hospice referral for your situation?
- Referral Timeliness Status (Multiple choice)How satisfied were you with the speed and responsiveness of the initial intake process?
- Overall Hospice Rating (Linear scale)On a scale from 1 to 5, how would you rate your overall experience with our hospice care team?
- Improvement Suggestions (Paragraph)What specific areas of our service could be improved?
- Additional Comments or Questions (Paragraph)Please share any additional thoughts, commendations, or notes for our care team.
FAQ
What is a hospice patient satisfaction survey?
It is a structured questionnaire used by healthcare providers to gather feedback from patients and families regarding the quality, timeliness, and compassion of hospice and end-of-life care services.
Who should fill out this survey?
The survey is typically completed by family members, primary caregivers, or patients themselves following their experience with hospice services.
Can I customize the questions on this Google Form template?
Yes! Once you generate the form using Doc2Form, you have full control in Google Forms to add, edit, or remove questions to fit your specific facility requirements.
How do I share this survey with families?
You can easily share the form by emailing a direct link, sending an SMS, or embedding it into your organization's post-care follow-up communications.
Where are survey responses stored?
All responses are automatically routed to a connected Google Sheets spreadsheet, giving your care team instant access to analytics and qualitative feedback.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.