Patient Survey

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. Ease in finding parking convenient to the emergency room?

  2. Courtesy of the registration/admission staff?

  3. Ease of registration/admission process?

  4. Adequacy of instructions about follow-up care?

  5. How long have you been going to this provider?

  6. In the last 12 months, how many times did you visit this provider to get care for yourself?

  7. Attitudes displayed by the physicians and medical providers towards requests made by your family and visitors?

  8. Friendliness of the staff involved in your care?

  9. Efforts of the staff to address you respectfully and by name?

  10. Efforts of the staff to always knock and ask permission to enter before opening the bathroom door?

  11. Efforts of the staff to always knock before entering your room?

  12. Adequacy of instructions about medications you were to take after discharge?

  13. Adequacy of instructions about the follow-up treatments you are to have after discharge?

  14. Efforts made by the staff to respect and accommodate special diet requests?

  15. Quality of the food?

  16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

  17. Friendliness of the staff who returned your calls after you left the surgery center?

  18. Understandability of pre-surgery instructions?

  19. Cleanliness of patient care area?

  20. Cleanliness of the Emergency Room?

  21. Cleanliness of the bathrooms?

  22. General cleanliness of the building?

  23. Efforts made by the staff to find solutions to any problems that came up during your care?

  24. Knowledge displayed by the staff involved in your visit?

  25. Cleanliness of your patient room?