Emergency One Patient Satisfaction Survey

	Excellent	Good	Adequate	Poor	Unacceptable	N/A
Comfort of our waiting room	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

Excellent

Good

Adequate

Poor

Unacceptable

N/A

Comfort of our waiting room

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

Question Title

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

Excellent

Good

Adequate

Poor

Unacceptable

Question Title

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

Complete

A lot

Some

Little

None

Question Title

* 4. Overall, is our performance ...

Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

Question Title

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

Certain

Very likely

Somewhat likely

Unlikely

Very unlikely

Question Title

* 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.

Emergency One Patient Satisfaction Survey

How Are We Doing?

Question Title

* 1. Please rate the following aspects of our work.

Question Title

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

Question Title

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

Question Title

* 4. Overall, is our performance ...

Question Title

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

Question Title

* 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.