Patient Discharge & Medical Release Experience Survey

Thanks for taking a few minutes to tell us about your recent discharge or release from our care. Your honest feedback helps us make sure patients leave with clear instructions. Your responses are completely confidential and anonymized. This will take about 4-5 minutes.

What type of visit were you discharged from?

• Emergency room
• Inpatient hospital stay
• Outpatient surgery or procedure
• Urgent care
• Other

Did you receive written discharge instructions before you left?

• Yes, complete written instructions
• Yes, but they were incomplete or hard to read
• No written instructions, verbal only
• I don't remember

Thinking about your discharge conversation, how much do you agree with each statement?

Was a follow-up appointment scheduled or clearly arranged before you left?

• Yes, scheduled before I left
• Yes, but I had to schedule it myself afterward
• No follow-up was needed
• I'm not sure if one was arranged

How confident did you feel about managing your recovery or condition at home right after discharge?

How would you rate the overall clarity of your medication instructions specifically?

In the 7 days after leaving, did you have to call the office, visit an ER, or get readmitted because something about the discharge instructions was unclear or wrong?

• No, everything was clear and went fine
• I called with a question but didn't need further care
• I sought additional care (ER visit, urgent care, or readmission)
• Not applicable / no issues arose yet

Reconstruct exactly what happened after the respondent left care: identify the single instruction (medication, activity restriction, warning sign, or follow-up step) that was least clear to them, ask what they actually did when they hit that confusion, and whether it led them to call the office, guess, ignore it, or seek additional care. If they said everything was clear, probe one specific detail (like a medication dose or a warning sign) to verify true understanding rather than general satisfaction. If they sought additional care afterward, get the specific timeline and root cause.

Is there anything about the discharge process you'd want us to change for the next patient?

What is your age range?

• 18-29
• 30-44
• 45-59
• 60-74
• 75+
• Prefer not to say

What is your gender?

• Woman
• Man
• Non-binary
• Prefer to self-describe
• Prefer not to say

Thank you for sharing your experience. Your responses go directly to our care quality team and help us improve discharge instructions and follow-up support for future patients.