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	Please check one Excellent	Please check one Good	Please check one Average	Please check one Poor

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* 2. Were Your benefits explained to you clearly ?

YES

NO

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* 3. The care I recieved from my therapist was:

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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* 5. Did the staff introduce themselves:

	Always	Usually	Seldom	Never
Please select one	Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

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* 6. The staff was courteous and considerate:

	Always	Usually	Seldom	Never
Please select one	Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

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

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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* 8. How well were your scheduling needs met ?

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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* 10. My privacy needs were respected:

	Always	Usually	Seldom	Never
Please select one	Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

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

	Always	Usually	Seldom	Never
Please select one	Please select one Always	Please select one Usually	Please select one Seldom	Please select one Never

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

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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

Yes

No

If No, why not:

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

	Excellent	Good	Average	Poor
Please select one	Please select one Excellent	Please select one Good	Please select one Average	Please select one Poor

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

	Excellent	Good	Average	Poor
Please choose one	Please choose one Excellent	Please choose one Good	Please choose one Average	Please choose one Poor

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

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* 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: