Connally Memorial Patient Satisfaction Survey Question Title * 1. Who was your provider? C. Alprin J. Brand E. Baden D. Blackburn R. DeLorenzo C. Grote K. Kingdon R. Poole J. Poplawsky J. Schiavone J. Pinnow I do not know Other (please specify) Question Title * 2. The registration staff treated me with courtesy and respect. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 3. The nurse treated me with kindness and compassion. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 4. The nurse treated me with courtesy and respect. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 5. The doctor treated me with kindness and respect. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 6. The doctor treated me with courtesy and respect. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 7. The doctor explained things in a way I could understand. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 8. The doctor took time to answer my questions. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 9. I felt my privacy was protected. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 10. The emergency department was clean and comfortable. Completely Agree Mostly Agree Neutral Mostly Disagree Disagree Question Title * 11. Would you recommend this Emergency Department to your friends and family? Definitely yes Probably yes Maybe Probably not Definitely not Question Title * 12. How would you rate your overall experience in the Emergency Department? Excellent Good Okay Below Average Poor Question Title * 13. Please provide feedback about your experience. Question Title * 14. Would you like to be contacted about your experience? Yes No Next