The Kansas City Orthopaedic Institute Patient Satisfaction Survey - Outpatient Rehabilitation

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1. I felt the hospital admission process was:

	Excellent	Good	Average	Poor
Please check one	*I felt the hospital admission process was: Please check one Excellent	Please check one Good	Please check one Average	Please check one Poor

2. Were Your benefits explained to you clearly ?

Were Your benefits explained to you clearly ?   YES NO

3. The care I recieved from my therapist was:

	Excellent	Good	Average	Poor
Please select one	*The care I recieved from my therapist was: Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

4. The therapist's efforts to explain things and make me feel more comfortable were:

	Excellent	Good	Average	Poor
Please select one	*The therapist's efforts to explain things and make me feel more comfortable were: Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

5. Did the staff introduce themselves:

	Always	Usually	Seldom	Never
Please select one	*Did the staff introduce themselves: Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

6. The staff was courteous and considerate:

	Always	Usually	Seldom	Never
Please select one	*The staff was courteous and considerate: Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

7. The degree to which my family or I was informed about my progress:

	Excellent	Good	Average	Poor
Please select one	*The degree to which my family or I was informed about my progress: Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

8. How well were your scheduling needs met ?

	Excellent	Good	Average	Poor
Please select one	*How well were your scheduling needs met ? Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

9. How clearly did the therapist explain what to expect from your treatments ?

	Excellent	Good	Average	Poor
Please select one	*How clearly did the therapist explain what to expect from your treatments ? Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

10. My privacy needs were respected:

	Always	Usually	Seldom	Never
Please select one	*My privacy needs were respected: Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

11. The degree to which my individual needs were met:

	Always	Usually	Seldom	Never
Please select one	*The degree to which my individual needs were met: Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

12. How would you rate you overall experience with the Rehabilitation Department ?

	Excellent	Good	Average	Poor
Please select one	*How would you rate you overall experience with the Rehabilitation Department ? Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

13. How would you recommend our hospital to your family and friends?

How would you recommend our hospital to your family and friends?   Yes No

If No, why not:

14. How pleasant and comfortable did you find the atmosphere, furnishings, cleanliness, etc at our hospital?

	Excellent	Good	Average	Poor
Please select one	*How pleasant and comfortable did you find the atmosphere, furnishings, cleanliness, etc at our hospital? Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

15. The amount of time you had to wait for your therapy ?

	Excellent	Good	Average	Poor
Please choose one	*The amount of time you had to wait for your therapy ? Please choose one Excellent	Please choose one Good	Please choose one Average	Please choose one Poor

16. What could we do to improve your experience at our hospital?

What could we do to improve your experience at our hospital?

17. If you would like to be contacted by a member of our management staff to discuss your stay with us please fill in your name and phone number with area code below:

If you would like to be contacted by a member of our management staff to discuss your stay with us please fill in your name and phone number with area code below: