Hospital Discharge Survey
Inpatient experience post-discharge.
Free to preview — no account needed. Using it creates your own editable copy.
Try the template
These are the real questions. Nothing you answer here is saved or submitted.
Nursing care*
About this template
Hospital Discharge Survey is a ready-to-use survey template with 5 questions that takes about 3 minutes to answer. Inpatient experience post-discharge.
Healthcare templates cover patient satisfaction, discharge follow-up, telemedicine and pharmacy experience. They are deliberately short: a patient completing a survey is often unwell, tired, or waiting for someone else. Keep clinical detail out of the questionnaire and collect only what you will act on — anything identifying belongs in your clinical system, not in a feedback form. Everything in this template is editable — treat the questions below as a starting point that already has the structure right, then cut what does not apply to you.
- Who should use it
- Hospitals, clinics, diagnostic centres, pharmacies and telemedicine providers.
- When to use it
- After discharge, after a consultation, or as a periodic check on a service line.
What this template helps you measure
- Staff performance
- Facilities and amenities
- Food and menu quality
Every question in this template
5 questions, with what each one is doing there. Change or remove any of them after you make your copy.
Nursing care*
Star ratingWhy this matters: Quick to answer and quick to read: the kind of question that keeps a response rate healthy.
Doctor visits*
Star ratingWhy this matters: Scoring how your people performed separately stops one weak area from being averaged away inside a single overall rating.
Cleanliness of room*
Star ratingWhy this matters: Gives you a baseline for facilities and the stay itself — the number that makes the next round of answers mean something.
Food quality*
Star ratingWhy this matters: Turns an impression of food and menu quality into a score, which is what lets you tell a genuine dip apart from a bad week of memories.
What stood out, good or bad?
Long textWhy this matters: Unprompted wording surfaces problems you did not think to ask about — the ones no fixed-option question in this template would have caught.
How to use this template
- 1
Start with the template
Click "Use this template" and SurveyKar creates your own copy of Hospital Discharge Survey, with every question already in place. The original template stays untouched.
- 2
Customise the questions
Reword anything that does not match your business, delete what you do not need, change a question type, or add your own. Shorter surveys finish more often — cut before you add.
- 3
Add your branding
Set your logo, brand colours, fonts and background so the page looks like it belongs to you rather than to a survey tool.
- 4
Share it
Publish, then share the link, print the QR code, embed it on your site, or send it to a contact list over email or WhatsApp.
- 5
Read the responses
Results land in your dashboard as they arrive, with charts per question, filters, sentiment analysis on open text, and CSV or PDF export.
What you can customise
Your copy is yours. Nothing in the template is locked, and the original is never changed by anything you do.
Questions and wording
Edit, reorder, delete or add questions. Nothing in the template is locked.
Question types
Swap a rating for NPS, a single choice for a matrix, or add ranking, sliders and file uploads.
Logo and brand colours
Apply your logo, primary colour, fonts and background image to the respondent page.
Conditional logic
Skip questions or branch to a different page based on an earlier answer. Available on the Basic plan and above.
Thank-you page
Write your own closing message, or redirect respondents to a URL of your choice after submitting.
Sharing and distribution
Share by link or QR code, embed it on your website, or send it out over email and WhatsApp campaigns.
Frequently asked questions
Related templates
All Healthcare templatesPharmacy Feedback Survey
Quick CSAT for retail pharmacies.
Mental Health Check-in
Brief well-being check-in for patients or employees.
Telemedicine Visit Feedback
Capture feedback after virtual consultations.
Clinic Feedback Form
Quick post-visit feedback for OPD and clinics.
Patient Satisfaction Survey
Standard HCAHPS-style patient experience survey.
Patient Satisfaction Survey
Measure patient experience post-visit.
Ready to create your survey?
Start with this ready-to-use template and customise it for your needs. You get your own copy in seconds — the template stays exactly as it is.