Emergency One Patient Satisfaction Survey

We're committed to monitoring the quality of the services that we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance. (All submissions are anonymous.)

1. Please rate the following aspects of our work.

	Excellent	Good	Adequate	Poor	Unacceptable	N/A
Comfort of our waiting room	*Please rate the following aspects of our work. Comfort of our waiting room Excellent	Comfort of our waiting room Good	Comfort of our waiting room Adequate	Comfort of our waiting room Poor	Comfort of our waiting room Unacceptable	Comfort of our waiting room N/A
Cleanliness of our facility	Cleanliness of our facility Excellent	Cleanliness of our facility Good	Cleanliness of our facility Adequate	Cleanliness of our facility Poor	Cleanliness of our facility Unacceptable	Cleanliness of our facility N/A
Reception staff was courteous, friendly & professional	Reception staff was courteous, friendly & professional Excellent	Reception staff was courteous, friendly & professional Good	Reception staff was courteous, friendly & professional Adequate	Reception staff was courteous, friendly & professional Poor	Reception staff was courteous, friendly & professional Unacceptable	Reception staff was courteous, friendly & professional N/A
Time spent with our nursing staff	Time spent with our nursing staff Excellent	Time spent with our nursing staff Good	Time spent with our nursing staff Adequate	Time spent with our nursing staff Poor	Time spent with our nursing staff Unacceptable	Time spent with our nursing staff N/A
Care given by our medical staff (MD, PA, NP)	Care given by our medical staff (MD, PA, NP) Excellent	Care given by our medical staff (MD, PA, NP) Good	Care given by our medical staff (MD, PA, NP) Adequate	Care given by our medical staff (MD, PA, NP) Poor	Care given by our medical staff (MD, PA, NP) Unacceptable	Care given by our medical staff (MD, PA, NP) N/A
Professionalism of our clinical staff	Professionalism of our clinical staff Excellent	Professionalism of our clinical staff Good	Professionalism of our clinical staff Adequate	Professionalism of our clinical staff Poor	Professionalism of our clinical staff Unacceptable	Professionalism of our clinical staff N/A
Treatment provided in a professional and confidential manner	Treatment provided in a professional and confidential manner Excellent	Treatment provided in a professional and confidential manner Good	Treatment provided in a professional and confidential manner Adequate	Treatment provided in a professional and confidential manner Poor	Treatment provided in a professional and confidential manner Unacceptable	Treatment provided in a professional and confidential manner N/A
Time spent with medical staff (MD, PA, NP)	Time spent with medical staff (MD, PA, NP) Excellent	Time spent with medical staff (MD, PA, NP) Good	Time spent with medical staff (MD, PA, NP) Adequate	Time spent with medical staff (MD, PA, NP) Poor	Time spent with medical staff (MD, PA, NP) Unacceptable	Time spent with medical staff (MD, PA, NP) N/A
Length of time spent in facility overall	Length of time spent in facility overall Excellent	Length of time spent in facility overall Good	Length of time spent in facility overall Adequate	Length of time spent in facility overall Poor	Length of time spent in facility overall Unacceptable	Length of time spent in facility overall N/A

2. Overall, how do you rate the quality of medical services we provide?

Overall, how do you rate the quality of medical services we provide? Excellent

Good

Adequate

Poor

Unacceptable

3. What level of confidence do you have in us to deliver the medical services that you require?

What level of confidence do you have in us to deliver the medical services that you require? Complete

A lot

Some

Little

None

4. Overall, is our performance ...

Overall, is our performance ... Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

5. Based on our performance, how likely is it that you will use us in the future?

Based on our performance, how likely is it that you will use us in the future? Certain

Very likely

Somewhat likely

Unlikely

Very unlikely

6. If you have any suggestions regarding how we could improve the services we provide to you, or if you would like to make a comment regarding the care that you received, please enter them in the box below.

If you have any suggestions regarding how we could improve the services we provide to you, or if you would like to make a comment regarding the care that you received, please enter them in the box below.