DA FORM 3611-R Fillable – Army Pubs 3611-R PDF

DAFORMFILLABLE.COM | DA FORM 3611-R Fillable – Army Pubs 3611-R PDF – In the realm of healthcare and military services, understanding and improving patient satisfaction in food services is crucial. The DA FORM 3611-R, known as the Food Service Division-Patient Satisfaction Survey (LRA), is a pivotal tool designed to gather feedback from patients regarding their experiences with food services within military healthcare facilities. This form provides essential data that can be used to enhance the quality of food service operations.

DA FORM 3611-R – Food Service Division-Patient Satisfaction Survey (LRA)

Form Number DA Form 3611-R
Form Title Food Service Division-Patient Satisfaction Survey (LRA)
Form Date 06/01/1970
Form Proponent TSG

Overview of DA FORM 3611-R

The DA FORM 3611-R was first introduced on June 1, 1970, and remains an active form used by The Surgeon General’s office (TSG). This form is unclassified and approved for public release, meaning its distribution is unlimited and can be accessed by anyone in need of conducting patient satisfaction surveys within the food service division of military hospitals or facilities.

Key Details of the Form

  • Pub/Form Number: DA FORM 3611-R
  • Pub/Form Date: 06/01/1970
  • Title: Food Service Division-Patient Satisfaction Survey (LRA)
  • Proponent: TSG (The Surgeon General)
  • Status: ACTIVE
  • Security Classification: UNCLASSIFIED
  • Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
  • Electronic Availability: This form is also available in electronic media, enhancing accessibility and ease of use.

Purpose of the DA FORM 3611-R

The primary purpose of the DA FORM 3611-R is to assess and collect patient feedback on the food services offered at military healthcare facilities. This survey allows food service personnel to identify strengths and weaknesses in their service delivery, facilitating continuous improvement and ensuring high standards of patient care and satisfaction.

Importance of Patient Feedback

Collecting patient feedback through the DA FORM 3611-R is essential for:

  • Enhancing Food Quality: Feedback helps in adjusting recipes, meal presentation, and variety.
  • Improving Service Delivery: Insights into the efficiency and friendliness of staff can lead to targeted training and operational changes.
  • Facility Management: Understanding patient needs can help in better allocation of resources and improvement in overall food service management.

How to Use DA FORM 3611-R

To effectively use the DA FORM 3611-R, healthcare providers and food service managers should follow these steps:

  1. Distribute Surveys: Provide the survey to patients who have experienced the food services at the facility.
  2. Collect and Analyze Data: After completion, collect the surveys and analyze the data to identify common trends and areas for improvement.
  3. Implement Changes: Based on the feedback, implement necessary changes to improve the food service operations.
  4. Follow-up Survey: Conduct follow-up surveys to assess the impact of the changes made and ensure continuous improvement.

Best Practices in Conducting Surveys

  • Ensure Anonymity: To get honest and constructive feedback, ensure that the surveys are anonymous.
  • Be Clear and Concise: The questions should be straightforward to avoid confusion and obtain accurate responses.
  • Regular Feedback Collection: Regularly use the DA FORM 3611-R to keep up with changes in patient preferences and expectations.


The DA FORM 3611-R – Food Service Division-Patient Satisfaction Survey (LRA) is more than just a form; it is a crucial tool in the feedback loop that helps military food service divisions maintain and improve the quality and efficiency of their operations. By utilizing this form effectively, facilities can ensure that they meet and exceed the dietary and service expectations of their patients, thereby enhancing the overall patient experience within military healthcare environments.

Incorporating this survey into regular operations is not just beneficial but essential for continuous improvement and patient-centered care in military food services.

DA FORM 3611-R Fillable – Army Pubs 3611-R PDF DOWNLOAD

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