BAY REGIONAL CANCER CENTER Survey

We thank you in advance for completing this questionnaire. Your thoughts and opinions are important to us. Please place a check in the column that best describes your experience. Space is also provided for you to comment on your experience at the end of the survey. When you have finished, please mail it in the enclosed envelope.

	Very Good	Good	Fair	Poor	Very Poor
If you spoke with the Cancer Center by phone, courtesy of the person you spoke with.	If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Very Good	If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Good	If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Fair	If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Poor	If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Very Poor
Courtesy of person at registration window	Courtesy of person at registration window Very Good	Courtesy of person at registration window Good	Courtesy of person at registration window Fair	Courtesy of person at registration window Poor	Courtesy of person at registration window Very Poor
Ease of registration process	Ease of registration process Very Good	Ease of registration process Good	Ease of registration process Fair	Ease of registration process Poor	Ease of registration process Very Poor

Very Good

Good

Fair

Poor

Very Poor

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with.

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Very Good

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Good

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Fair

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Poor

If you spoke with the Cancer Center by phone, courtesy of the person you spoke with. Very Poor

Courtesy of person at registration window

Courtesy of person at registration window Very Good

Courtesy of person at registration window Good

Courtesy of person at registration window Fair

Courtesy of person at registration window Poor

Courtesy of person at registration window Very Poor

Ease of registration process

Ease of registration process Very Good

Ease of registration process Good

Ease of registration process Fair

Ease of registration process Poor

Ease of registration process Very Poor

	Very Good	Good	Fair	Poor	Very Poor
Cleanliness of the facility	Cleanliness of the facility Very Good	Cleanliness of the facility Good	Cleanliness of the facility Fair	Cleanliness of the facility Poor	Cleanliness of the facility Very Poor
Ease of finding your way around	Ease of finding your way around Very Good	Ease of finding your way around Good	Ease of finding your way around Fair	Ease of finding your way around Poor	Ease of finding your way around Very Poor
Comfort of the waiting room	Comfort of the waiting room Very Good	Comfort of the waiting room Good	Comfort of the waiting room Fair	Comfort of the waiting room Poor	Comfort of the waiting room Very Poor

Very Good

Good

Fair

Poor

Very Poor

Cleanliness of the facility

Cleanliness of the facility Very Good

Cleanliness of the facility Good

Cleanliness of the facility Fair

Cleanliness of the facility Poor

Cleanliness of the facility Very Poor

Ease of finding your way around

Ease of finding your way around Very Good

Ease of finding your way around Good

Ease of finding your way around Fair

Ease of finding your way around Poor

Ease of finding your way around Very Poor

Comfort of the waiting room

Comfort of the waiting room Very Good

Comfort of the waiting room Good

Comfort of the waiting room Fair

Comfort of the waiting room Poor

Comfort of the waiting room Very Poor

	Very Good	Good	Fair	Poor	Very Poor
Wait time for your scheduled radiation treatment time	Wait time for your scheduled radiation treatment time Very Good	Wait time for your scheduled radiation treatment time Good	Wait time for your scheduled radiation treatment time Fair	Wait time for your scheduled radiation treatment time Poor	Wait time for your scheduled radiation treatment time Very Poor
Staff concern for your comfort during your radiation therapy	Staff concern for your comfort during your radiation therapy Very Good	Staff concern for your comfort during your radiation therapy Good	Staff concern for your comfort during your radiation therapy Fair	Staff concern for your comfort during your radiation therapy Poor	Staff concern for your comfort during your radiation therapy Very Poor
Staff courtesy during your radiation therapy	Staff courtesy during your radiation therapy Very Good	Staff courtesy during your radiation therapy Good	Staff courtesy during your radiation therapy Fair	Staff courtesy during your radiation therapy Poor	Staff courtesy during your radiation therapy Very Poor

Very Good

Good

Fair

Poor

Very Poor

Wait time for your scheduled radiation treatment time

Wait time for your scheduled radiation treatment time Very Good

Wait time for your scheduled radiation treatment time Good

Wait time for your scheduled radiation treatment time Fair

Wait time for your scheduled radiation treatment time Poor

Wait time for your scheduled radiation treatment time Very Poor

Staff concern for your comfort during your radiation therapy

Staff concern for your comfort during your radiation therapy Very Good

Staff concern for your comfort during your radiation therapy Good

Staff concern for your comfort during your radiation therapy Fair

Staff concern for your comfort during your radiation therapy Poor

Staff concern for your comfort during your radiation therapy Very Poor

Staff courtesy during your radiation therapy

Staff courtesy during your radiation therapy Very Good

Staff courtesy during your radiation therapy Good

Staff courtesy during your radiation therapy Fair

Staff courtesy during your radiation therapy Poor

Staff courtesy during your radiation therapy Very Poor

	Very Good	Good	Fair	Poor	Very Poor
Doctor's discussion of your treatment options	Doctor's discussion of your treatment options Very Good	Doctor's discussion of your treatment options Good	Doctor's discussion of your treatment options Fair	Doctor's discussion of your treatment options Poor	Doctor's discussion of your treatment options Very Poor
Amount of time your doctor spent with you	Amount of time your doctor spent with you Very Good	Amount of time your doctor spent with you Good	Amount of time your doctor spent with you Fair	Amount of time your doctor spent with you Poor	Amount of time your doctor spent with you Very Poor
How well your doctor kept you informed about your condition and treatment plan	How well your doctor kept you informed about your condition and treatment plan Very Good	How well your doctor kept you informed about your condition and treatment plan Good	How well your doctor kept you informed about your condition and treatment plan Fair	How well your doctor kept you informed about your condition and treatment plan Poor	How well your doctor kept you informed about your condition and treatment plan Very Poor
Doctor's concern for your questions and worries	Doctor's concern for your questions and worries Very Good	Doctor's concern for your questions and worries Good	Doctor's concern for your questions and worries Fair	Doctor's concern for your questions and worries Poor	Doctor's concern for your questions and worries Very Poor
Skill and knowledge of the doctor	Skill and knowledge of the doctor Very Good	Skill and knowledge of the doctor Good	Skill and knowledge of the doctor Fair	Skill and knowledge of the doctor Poor	Skill and knowledge of the doctor Very Poor

Very Good

Good

Fair

Poor

Very Poor

Doctor's discussion of your treatment options

Doctor's discussion of your treatment options Very Good

Doctor's discussion of your treatment options Good

Doctor's discussion of your treatment options Fair

Doctor's discussion of your treatment options Poor

Doctor's discussion of your treatment options Very Poor

Amount of time your doctor spent with you

Amount of time your doctor spent with you Very Good

Amount of time your doctor spent with you Good

Amount of time your doctor spent with you Fair

Amount of time your doctor spent with you Poor

Amount of time your doctor spent with you Very Poor

How well your doctor kept you informed about your condition and treatment plan

How well your doctor kept you informed about your condition and treatment plan Very Good

How well your doctor kept you informed about your condition and treatment plan Good

How well your doctor kept you informed about your condition and treatment plan Fair

How well your doctor kept you informed about your condition and treatment plan Poor

How well your doctor kept you informed about your condition and treatment plan Very Poor

Doctor's concern for your questions and worries

Doctor's concern for your questions and worries Very Good

Doctor's concern for your questions and worries Good

Doctor's concern for your questions and worries Fair

Doctor's concern for your questions and worries Poor

Doctor's concern for your questions and worries Very Poor

Skill and knowledge of the doctor

Skill and knowledge of the doctor Very Good

Skill and knowledge of the doctor Good

Skill and knowledge of the doctor Fair

Skill and knowledge of the doctor Poor

Skill and knowledge of the doctor Very Poor

BAY REGIONAL CANCER CENTER

1. BAY REGIONAL CANCER CENTER

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* 1. Registration

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* 2. Facility

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* 3. Radiation Therapy

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* 4. Oncologist (Physician)

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* 5. Please share any comments regarding your experience at Bay Regional Cancer Center:

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* 6. Patients Name(Optional)

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* 7. Telephone number(optional)