Patient education survey is a tool to gather information so as to know that how much awareness and knowledge a patient has about the treatment he is getting from the concerned doctor. This survey consists of questions which are direct and written in easy language for the patients to answer.

Sample Patient Education Survey:

  1. Name:
  2. Was the doctor capable of informing you of your disease properly?
    1. Yes
    2. No
  3. Did you get detailed information about the disorder and its consequence?
    1. Yes
    2. No
  4. Were you provided with printed educative material?
    1. Yes
    2. No
  5. Do you receive periodic newsletters through email?
    1. Yes
    2. No
  6. Are you aware about the medication provided by the doctor?
    1. Yes
    2. No
  7. Is the medication effective?
    1. Yes
    2. No
  8. Do you think your treatment could have been done in a better way?
    1. Yes
    2. No
  9. How long did it take for you to get treated completely?

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