Hospital Patient Release Feedback Questionnaire
Personal Information
Full Name
Patient ID (if known)
Age
Date of Discharge
Feedback on Release Process
How would you rate the discharge process?
Excellent
Good
Average
Poor
Was information about home care provided?
Yes
No
Partially
Were your medications and instructions explained clearly?
Yes
No
Partially
Were your questions addressed before discharge?
Yes
No
Partially
Overall Experience
Would you recommend our hospital to others?
Yes
No
Additional comments or suggestions