Mental Health Inpatient Patient and Family Experience Survey
1.
Who is completing this survey?
Patient
Family Member/Caregiver
2.
Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?
Never
Sometimes
Usually
Always
Don't know/Not sure
3.
Did the health professionals treating and examining you introduce themselves?
Yes, all of the staff introduced themselves
Some of the staff introduced themselves
Very few of the staff introduced themselves
Don't know/Can't remember
4.
During this hospital stay, did you get all of the information you needed about your condition and treatment?
Never
Sometimes
Usually
Always
5.
Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit?
Never
Sometimes
Usually
Always
Not applicable
6.
Were you involved as much as you wanted to be in decisions about your care and treatment?
Never
Sometimes
Usually
Always
7.
Were you able to get a member of the hospital staff to help you when you needed attention?
Yes, always
Sometimes
No, never
I did not need attention
8.
I was assured my personal information was kept confidential.
Strongly Disagree
Disagree
Agree
Strongly Agree
Not applicable
9.
I felt safe in the facility at all times.
Strongly Disagree
Disagree
Agree
Strongly Agree
Not applicable
10.
Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your hospital stay?
Not at all
Partly
Quite a bit
Completely
Not applicable
11.
Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?
Not at all
Partly
Quite a bit
Completely
12.
The services I have received have helped me deal more effectively with my life's challenges
Strongly Disagree
Disagree
Agree
Strongly Agree
Not applicable
13.
Overall...(Please pick a number)
0 I had a very poor experience
1
2
3
4
5
6
7
8
9
10 I had a very good experience
14.
What else would you like to say about this inpatient experience?
(Please do not include any names, contact information, or identifying information)
15.
Is there a staff member or group that you would like to recognize for providing exceptional care or service?
If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.
