Thank you for taking the time to complete this survey. Please answer the following questions to the best of your ability.

Please enter your responses below:

  1. Clinic staff reception, ease of scheduling?

  2. Admission staff efforts to minimize the time the admission process took by collecting information before your arrival in labor?

  3. Efforts of the staff to include your significant other in the delivery process to the level that you desired?

  4. Attitudes displayed by the physicians and medical providers towards your requests?

  5. Efforts of the staff to always introduce himself or herself to you and your family?

  6. Skill displayed by the staff involved in your care?

  7. Respectfulness displayed to you by the staff?

  8. Teamwork displayed between the people involved in your care?

  9. Efforts of the staff to explain the labor process to your satisfaction so you understood the progress of your delivery?

  10. Efforts of the staff to create a delivery experience that you found to be satisfying?

  11. Efforts of the staff to always explain any changes in planned activities?

  12. Was pain controlled to the level you desired?

  13. Efforts of the staff to always wash his or her hands prior to a procedure or administering a medication?

  14. Efforts made by staff to ensure your privacy; both pre-natal and delivery.

  15. Efforts of the staff to explain your baby's care or procedures before starting?

  16. Adequacy of instructions about discharge care instructions for your new baby?

  17. Quality, apperance and variety of the food?

  18. Cleanliness of your patient room?

  19. Would you recommend this hospital to family and friends?

  20. If no, why?

  21. For any areas that you were unsatisfied with, what could we have done to make it better during your visit?

  22. If there was one thing that made your visit to our facility seem special, what was it?

  23. Was there any one staff member who made your experience great?