国际医学部跨境医疗患者满意度调查表Cross-border International Patient Satisfaction Survey

尊敬的女士/先生:

您好!非常感谢您选择在本院接受医疗服务。为了帮助我们更好地了解您的就医体验,并持续改进对跨境患者的服务质量,恳请您花3-5分钟填写这份匿名问卷。您的真实反馈对我们非常重要。所有数据仅用于服务质量改进,不会涉及您的个人隐私。


Dear Patient,

Thank you for choosing our hospital for your medical care. To better understand your experience and continuously improve our services for cross-border patients, please take 3-5 minutes to complete this anonymous survey. Your honest feedback is crucial for quality improvement.

请选择问卷语言 / Please select your preferred language
中文
English
姓名
    ____________
病案号
    ____________
您选择在本院就医的主要原因(可多选)
医疗技术/专家水平高
就医等待时间短
国内/居住国无法提供所需治疗
经亲友推荐
医院声誉良好且具备权威资质认证
医疗费用合理
其他
在抵达医院前,我通过线上咨询获得了清晰的就医流程和所需材料信息
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医院提供了我能理解的语言版本的费用预估,且无意外收费
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医院在行程安排(如交通、住宿、签证办理等)方面提供了有效的协助
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
费用结算流程清晰、便捷
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医护人员能够用我熟悉的语言清晰地解释病情和治疗方案
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医院提供了我能理解的语言版本的知情同意书和诊疗说明
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医护人员尊重我的文化背景、习俗或宗教信仰
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医生的专业能力和诊疗水平符合我的期望
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
护士及其他医务人员的护理操作专业、规范
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医院环境的清洁程度和隐私保护措施(如一人一诊室)让我感到舒适
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
医院提供的住宿协调、餐饮等配套服务质量良好
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
当我遇到问题或不满时,医院能够及时响应并妥善处理
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
出院时,医生或护士详细告知了我的康复计划和注意事项
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
总体而言,医院在整个就医旅程中的协调让我感到安心
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
总体而言,我对这次跨境就医的整体体验感到满意,愿意推荐给亲友
非常同意
同意
一般
不同意
非常不同意
不适用
请说明原因
    ____________
您觉得这个医院哪些方面还可以提升,做得更好的?请详细描述
    ____________
请问在整个住院期间,医院有什么让您感动或满意的人或事吗?请具体描述
    ____________
Name
    ____________
Medical record number
    ____________
Main reasons for choosing our hospital
High level of medical technology / expertise
Short waiting time
Treatment unavailable in home country
Referral from friends/family
Good hospital reputation and accreditation
Transparent pricing and affordable cost
Others
Before coming to the hospital, the hospital clearly informed me, through online channels, of what I needed to do upon arrival and what documents I needed to bring.
Strongly Agree
Agree
Neutral / Somewhat Agree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The hospital provided a cost estimate in a language I understand, with no unexpected charges.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The hospital provided effective logistical support for my travel needs (e.g., transportation, accommodation, visa application assistance, etc.).
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The billing and payment process is clear and convenient.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Medical staff explained my condition/treatment clearly in a language I understand.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The hospital provided informed consent and medical instructions in a language I understand. 
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Medical staff respected my cultural background, customs, or religious beliefs.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The doctor's professional competence and treatment met my expectations. 
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Procedures performed by nurses and other medical staff are professional and standardized.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
The cleanliness and privacy protection made me feel comfortable.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Support services such as accommodation coordination and meals were of good quality.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
When I encountered a problem or dissatisfaction, the hospital responded promptly and handled it appropriately.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Upon discharge, the doctor/nurse explained the recovery plan and precautions after returning home.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Overall, the hospital's coordination throughout the entire care journey (from inquiry to post-return) made me feel at ease. 
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
Overall, I am satisfied with my cross-border medical experience and would recommend it to family/friends.
Strongly Agree
Agree
Neutral / Somewhat Agree
Disagree
Strongly Disagree
Not applicable
Please specify reason 
    ____________
In what areas do you think this hospital could improve or do better? Please describe in detail.
    ____________
During your entire hospitalization, was there any person or event that made you particularly satisfied? Please describe in detail.
    ____________

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