Understand and enhance healthcare services with our Healthcare Assessment Survey Template—designed for valuable insights
Identify improvement areas in healthcare services with Zonka Feedback's Healthcare Assessment Survey Template. Gather insights on health, lifestyle, services, and insurance to enhance care quality and address key concerns effectively.
22
24
3 mins
The following questions are included in this template form.
1. How old are you?
2. What is your gender?
3. What is your ethnic background?
4. What is your employment status?
5. How would you rate your overall physical health?
6. How would you rate your overall mental/emotional health?
7. How would you rate your stress and anxiety levels?
8. Do you have any chronic health conditions?
9. Please specify your chronic health conditions.
10. Do you have any hereditary conditions/diseases?
11. Please specify your hereditary conditions/diseases
12. Do you smoke or use tobacco products?
13. How often do you consume alcohol?
14. How would you rate your level of physical activity?
15. How many hours of sleep do you typically get per night?
16. Do you have any allergies
17. How often do you visit your primary care physician?
18. Have you ever been admitted to the hospital?
19. Please specify your reason for hospitalization
20. Do you have health insurance?
21. If you do not have health insurance, why not?
22. Please share any additional comments or concerns regarding your health assessment.
The template provides a solid foundation for gathering valuable insights and public health assessments. However, to ensure the survey aligns perfectly with community needs and your healthcare organization's goals, resources, and target audience, consider customizing the questions. Here are some suggestions:
Add or remove questions: Depending on your specific areas of interest and resources, you may want to include additional questions or remove existing ones to focus on the most relevant topics identified for your organization.
If you're focusing on preventive care, you could add a question like: "Have you received a flu shot in the past year?"
Modify question-wording: Adjust the language of questions to make them more relevant or understandable to your patients. This can help improve response rates and ensure that you're getting accurate health information.
Instead of asking, "How would you rate your overall physical health?", you could ask, "How often do you experience physical pain or discomfort?"
Add branching logic: Create conditional questions that only appear based on a previous response. This can help streamline the survey experience for patients and gather more specific data.
If a patient answers "yes" to the question "Do you have any chronic health conditions?", you could follow up with a question like: "Which chronic health conditions do you have?"
Consider patient demographics: If you're planning on targeting a particular patient demographic, such as seniors or children, you may want to include questions that are more relevant to that population and their specific local public health systems and needs.
If you're targeting seniors, you could ask a question like: "How often do you have difficulty walking or climbing stairs?"
1. Sign Up for a Free Trial: Get started by signing up for a free trial on Zonka Feedback. Once logged in, you can access the survey templates library, including the free Healthcare Assessment Survey Template.
2. Customize the Template: When in editing mode, you have full control to tailor the Template to your specific needs:
White-label the survey: Add your brand's logo, colors, and branding elements.
Modify questions: Gather feedback on specific aspects of healthcare, such as health status, lifestyle, services, or insurance.
Set up survey logic: Create personalized experiences based on customer responses, like showing follow-up questions based on initial answers.
Adjust the theme: Align the survey's look and feel with your brand's aesthetics.
Choose a language: Cater to your diverse patient base and ensure accessibility across regions.
3. Preview the Survey: Before sharing the survey, use Zonka Feedback's preview feature to see how it will appear to your patients. Ensure the questions, branding, and design are exactly how you want them. Make any final tweaks to perfect the survey.
4. Distribute the Survey Across Multiple Channels: With Zonka Feedback, you can distribute your survey via multiple channels to reach your audience wherever they are:
Web: Embed the survey directly on your website.
In-app: Collect feedback from patients using your mobile app.
Email: Send personalized surveys directly to your patients' inboxes.
SMS: Reach your audience via text messages, allowing for quick and easy responses.
Offline: Utilize the survey in physical locations like clinics or events.
QR Codes: Share via QR codes in physical spaces for easy, contactless survey participation.
1. Integrate: Seamlessly integrate Zonka Feedback with your existing healthcare systems:
CRMs: Sync patients data and feedback for holistic insights.
Helpdesks: Trigger surveys post-appointments and centralize feedback.
Electronic Health Records (EHRs): Connect survey data with patients medical records for comprehensive analysis.
Custom integrations: Extend Zonka Feedback's capabilities into your specific healthcare tech stack.
2. Automate: Streamline your development and feedback process:
Trigger surveys automatically: After appointments, treatments, or follow-ups.
Customize workflows: Manage feedback based on patient satisfaction levels.
Automate survey distribution: Via email, SMS, in-app, or QR codes.
3. Analyze: Gain in-depth insights into the public's health data:
Snapshot Reports: Get an overview of participant satisfaction.
Insights and Trends: Track patient's experience over time.
Word Analysis: Uncover recurring themes in open-ended feedback.
AI Sentiments: Analyze the emotional tone of feedback.
AI Themes and Subthemes: Categorize feedback into themes.
AI-Based Reports: Generate reports highlighting critical insights.
4. Act and Close the Loop: Take real-time action on feedback:
Send personalized follow-ups: Thank satisfied patients and address concerns.
Manage concerns: Create tasks for your team to take action.
Collaborate across departments: Ensure effective community health improvement plan based on feedback.
Zonka Feedback offers a variety of distribution channels to help physicians and healthcare organizations effectively reach their patients and gather valuable feedback. These channels were developed to ensure that the survey is accessible to a wide range of communities, regardless of their preferences or technological capabilities.
Digital Channels:
Website Integration: Embed the survey directly on your healthcare organization's website. This allows patients to easily take and complete the survey while visiting your online platform.
Email Campaigns: Send personalized survey invitations to patients via email. You can segment your patient list to tailor the survey to specific demographics or groups.
Social Media: Share the survey link on your healthcare organization's social media platforms, such as Facebook, Twitter, or Instagram. This can reach a wider audience and encourage patient participation.
QR Codes: Place QR codes in your physical locations, such as waiting rooms or examination rooms. Patients can scan the QR code with their smartphones to access the survey.
Mobile App Integration: If your healthcare organization has a mobile app, integrate the survey directly into it. This provides a convenient way for patients to access the survey on their mobile devices.
SMS: Send survey links to patients via text message. This is a quick and efficient way to reach patients who may not frequently check their email.
In-Person Channels:
Paper Surveys: Distribute paper surveys to patients in waiting rooms or during appointments. This is a traditional method that can be effective for patients who prefer to provide feedback in a physical format.
Kiosks: Set up self-service kiosks in your healthcare facilities. Patients can use these kiosks to complete the survey independently.
Third-Party Integrations:
CRM Systems: Integrate Zonka Feedback with your existing CRM system to automatically send surveys to patients based on their interactions or demographics.
Patient Portals: Embed the survey within your patient portal, making it easily accessible for patients who use this platform to manage their healthcare information.
By utilizing these distribution channels, you can ensure that your healthcare assessment survey reaches a diverse range of individuals and gathers valuable feedback to enhance your own community engagement and health improvement planning process (4). This will help you address key concerns (12) and improve the overall health and well-being of your community.
1. Patient Data and Insights -
Uncover hidden trends: Gather comprehensive data on patient health status, medical history, and lifestyle to identify underlying patterns and trends.
Predict future needs: Use data-driven insights to anticipate patient needs and proactively address potential health risks.
Deliver personalized care: Tailor treatment plans to individual patient needs based on their unique health profiles.
2. Patient Satisfaction and Experience -
Measure and enhance patient satisfaction: Gauge patient satisfaction with various aspects of healthcare and identify areas for improvement.
Drive a culture of patient-centered care: Foster a patient-centric approach to healthcare delivery by prioritizing patient feedback and needs.
Improve patient retention and loyalty: Increase loyalty and retention by delivering exceptional healthcare experiences.
3. Quality of Care -
Evaluate treatment effectiveness: Assess the effectiveness of treatments and interventions to ensure optimal patient outcomes.
Identify gaps in care: Pinpoint areas where care may be lacking or inconsistent and take corrective action.
Ensure adherence to clinical guidelines: Promote adherence to best practices and clinical guidelines to maintain high standards of care.
4. Benchmarking -
Compare performance to industry standards: Evaluate your healthcare organization's performance against industry benchmarks.
Identify opportunities for improvement: Pinpoint areas where your organization can enhance its services and outcomes.
Demonstrate excellence: Showcase your commitment to quality care and differentiate your organization from competitors.
5. Regulatory Compliance -
Ensure compliance with healthcare regulations: Stay up-to-date with relevant healthcare regulations and ensure your organization complies.
Identify potential risks: Proactively identify areas of non-compliance and take corrective measures.
Avoid penalties and fines: Minimize the risk of penalties and fines associated with regulatory violations.
6. Community Health Assessment -
Assess community health needs: Gain a deeper understanding of the health needs and challenges within your community.
Develop targeted interventions: Design and implement interventions to address specific health issues and improve community health outcomes.
Monitor progress and outcomes: Track the effectiveness of your interventions and make data-driven adjustments as needed.
Customizable Templates: Tailor the healthcare assessment survey to your specific needs, focusing on relevant questions for your patient population and healthcare services
Smart Survey Flow: Use branching logic to ask follow-up questions based on initial responses, providing deeper insights into patient experiences and concerns.
Real-Time Alerts: Receive immediate notifications when patients submit feedback, allowing for prompt responses and issue resolution.
Multi-Channel Distribution: Distribute surveys through various channels, such as email, SMS, or in-app, to reach a wider range of patients.
Multi-Lingual Support: Provide surveys in multiple languages to accommodate patients from diverse backgrounds.
Actionable Insights: Analyze feedback to evaluate areas for improvement in healthcare services, address any concerns, and enhance their overall experience.
A pre-designed, full health assessment and questionnaire form helps hospitals, clinics, and healthcare centers gather important information about patients' health concerns, medical history, lifestyle factors, and healthcare experiences. It enables healthcare providers to assess patients' needs, improve care quality, and enhance overall outcomes.
Using community health assessments provides several benefits. It allows you to gather comprehensive information about patients, make more informed decisions regarding the implementation of their treatment, and areas for improvement in healthcare services, and enhance overall patient satisfaction.
Yes, the community health assessment template offered by Zonka Feedback can be customized according to the specific requirements of your local hospital, clinic, or healthcare center. You can modify the questions, add or remove sections, and tailor the survey to gather the most relevant information for your organization.
The healthcare assessment survey process can be designed to accommodate both online and in-person completion. You can provide patients with the option to complete the the assessment survey process virtually by sending them the survey via SMS, email, website, in-app, and embedded link or by providing printed copies of the survey to be filled out during their visit.
Web Surveys%201.svg)
Email Surveys%201.svg)
SMS Surveys
WhatsApp Surveys%201.svg)
In-App Feedback%201%20(1).svg)
In-Product Feedback%201.svg)
Offline Surveys.svg)
In-App Mobile SDK
.svg)
%201%20(1).svg)
.svg)
.svg)
Salesforce 
HubSpot
ActiveCampaign
Pipedrive
Mailchimp
Zendesk 
Intercom
Freshdesk
HelpScout 
Front
Jira
Slack 
MS Teams
Webex
Zoom
Google Sheets 
Zapier 
Integrately
Make 
Webhooks 
Developer APIs
