Post-Surgery Patient Feedback Form
Patient Name
Date of Surgery
Department / Doctor
Overall Experience
Excellent
Good
Average
Poor
How would you rate the care you received from the staff?
Excellent
Good
Average
Poor
Was the communication about your procedure and recovery clear?
Yes, all the time
Sometimes
No
How satisfied were you with pain management?
Very satisfied
Satisfied
Neutral
Dissatisfied
How would you rate the hospital facilities?
Excellent
Good
Average
Poor
Additional Comments or Suggestions