Hospital Post-Discharge Follow-Up Survey
Patient Information
Name
Date of Birth
Admission Date
Discharge Date
Experience with Post-Discharge Care
Did you understand the instructions given at discharge?
Yes
No
Somewhat
Were you able to get the prescribed medications?
Yes
No
Did you have any difficulty scheduling follow-up appointments?
Yes
No
Have any of your symptoms returned or worsened since discharge?
Yes
No
Overall, how satisfied are you with the post-discharge care?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Additional Comments
Please provide any additional feedback or suggestions