Hospital Patient Survey.

Was this your first time as a patient at [Hospital]? Yes No How did you select [Hospital]? Please select one ... My doctor insisted it be this hospital My doctor recommended My doctor gave options It was my choice I insisted it be this hospital My insurance determined it I came through emergency dept What is the specialty of the doctor who admitted you to this hospital? General/Family/Internal Pediatrician OB/GYN Ear, Nose, Throat General Surgery Neurosurgery Urology Orthopedic Cancer/Tumor How many days were you in the hospital? 1 to 3 days 4 to 6 days 7 or more What type of unit were you in for most of your stay? Please select one or more ... Maternity General Surgical Intensive/Critical Rehabilitation Pediatric Children's Has one of your relatives or friends ever been a patient in this hospital? Yes No Please rate these statements   Agree/Disagree Please comment Highest quality doctor staff in the area                      Totally Agree Somewhat Agree Neither Agree, Nor Disagree Somewhat Disagree Totally Disagree Highest quality nursing staff in the area                      Totally Agree Somewhat Agree Neither Agree, Nor Disagree Somewhat Disagree Totally Disagree Most up-to-date medical equipment                      Totally Agree Somewhat Agree Neither Agree, Nor Disagree Somewhat Disagree Totally Disagree Most up-to-date facilities in the area                      Totally Agree Somewhat Agree Neither Agree, Nor Disagree Somewhat Disagree Totally Disagree While I was being registered   Disagree Neutral Agree The staff was caring The staff was professional The staff was considerate The staff was attentive Physician Staff   Disagree Neutral Agree My doctors were skilled and experienced My doctor was kind and caring My doctor kept me fully informed Communications   Disagree Neutral Agree Tests and procedures were completely explained to me Nursing Staff   Disagree Neutral Agree The nurses were skilled in the treatment provided me The nurses were responsive when I called