Objective To investigate hospitalized patients′ preferences for companion-free care services and identify the factors influencing their choices, thereby providing practical evidence for optimizing companion-free care services. Methods Using a convenience sampling method, 199 hospitalized patients from pilot departments were recruited between July and August 2025. Data regarding patients′ preferences for companion-free care services and related characteristics were collected using a self-developed questionnaire. Logistic regression analysis was performed to identify factors associated with patients′ preferences for companion-free care services. Results Of the 199 hospitalized patients, 160 (80.40%) chose companion-free care services. Among these patients, 141 (88.12%) preferred a one-to-three care model. Patient age and hospital department were identified as significant factors influencing the choice of companion-free care services (both P<0.05). Conclusion Hospitalized patients demonstrated a high level of acceptance of companion-free care services, with the one-to-three care model being the most preferred option. Increasing age and hospitalization in orthopedic departments were facilitating factors associated with the selection of companion-free care services. Future efforts should focus on continuously optimizing service processes and quality while tailoring professional care content to the diverse care needs of patients across different age groups and disease categories.