South Peninsula Hospital
Satisfaction Survey
|
Please help us improve by taking a few minutes to complete this
questionnaire regarding your recent hospital visit. We need your
comments and suggestions. The information provided will be used to
evaluate the quality of care and service we provide.
After filling out, please print out and
either drop off at SPH or mail to: |
|
Where did you receive your care? |
Emergency Department | Radiology / Imaging |
| Acute Care | Birthing Center | |
| Surgery | Laboratory | |
| Physical / Occupational Therapy |
| Please rate the following aspects of your care. | Very Satisfied | Acceptable | Dissatisfied | |
| 1 |
What was your overall impression of our hospital? |
|||
| 2 |
How well did we meet your personal and special needs? |
|||
| 3 |
Were you included in the decisions made regarding your care? |
|||
| 4 |
Was the staff courteous and cheerful? |
|||
| 5 |
Did the staff explain your procedures, medications and care in a way that you could understand? |
|||
| 6 |
Did you feel the staff listened carefully to you? |
|||
| 7 |
Did the staff respond to your concerns? |
|||
| 8 |
Did the staff respond to your requests in a reasonable amount of time? |
|||
| 9 | How well did the staff work together to care for you? | |||
| 10 |
Would you use our hospital again? |
Yes | No | |
| 11 |
Would you recommend our hospital to others? |
Yes | No | |
12. What was one thing we
did very well?
13. Was there anything
about your visit that caused you frustration?
14. Please list any staff
members you would like to give special recognition:
15. Other
comments/suggestions:
We invite you to include your name and contact number for personal follow up. To talk personally with one of our staff members please call the Quality Improvement office at 235-0318.
Name (Optional): Phone #:
Thank You For Taking Time To Answer This Survey!