Laboratory Department Excelsior Springs Hospital Survey

Thank you for using the Laboratory Department at ESH. We realize that you have many choices available to you when making health care choices for your family. We appreciate the fact you chose our hospital and want to make sure your visit met or exceeded your expectations. Please take a moment to complete this brief survey.

Your thoughts will help us provide better service to all of our patients in the future!

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* 1. What was your overall opinion of the laboratory department?

Excellent

Very Good

Good

Fair

Poor

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* 2. Was this your first visit to our hospital?

Yes

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* 3. Would you choose our laboratory department again?

Yes

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* 4. Would you recommend our laboratory department to your family and friends?

Definitely yes

Probably yes

Probably no

Definitely no

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* 5. Members of your family and /or friends were served satisfactorily by our staff.

Strongly Agree

Agree

N/A

Disagree

Strongly disagree

If you selected disagree, please explain.

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* 6. What type of Lab service did you receive today?

Therapeutic Phlebotomy

Blood Draw (Venipuncture)

Transfusion with Blood Products

Other

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* 7. The time that you waited for Lab assistance was:

Excellent

Very Good

Good

Fair

Poor

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* 8. The staff was compassionate and caring.

Strongly Agree

Agree

Disagree

Strongly disagree

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* 9. When you asked questions did you get enough information from the staff?

Always

Usually

Sometimes

Never

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* 10. Did the staff respect and protect your privacy?

Always

Usually

Sometimes

Never

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* 11. Did the phlebotomist/technologist verify your name and date of birth before they performed your procedure today?

Yes

Unsure

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* 12. Name one suggestion that would have improved your experience?

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* 13. Adequate precautions were taken for your safety.

Always

Usually

Sometimes

Never

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* 14. Please rate the service you received from the following departments.

	Excellent	Good	Fair	Poor	N/A
Admitting	Admitting Excellent	Admitting Good	Admitting Fair	Admitting Poor	Admitting N/A
Laboratory	Laboratory Excellent	Laboratory Good	Laboratory Fair	Laboratory Poor	Laboratory N/A
Volunteers	Volunteers Excellent	Volunteers Good	Volunteers Fair	Volunteers Poor	Volunteers N/A

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* 15. Did you have any concerns or questions that were not addressed to your satisfaction?

Yes

Other comments

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* 16. Date of visit.

Thank you for taking the time to fill out our suvey so that we may improve our services to our patients. Your suggestions are very important to us. The following questions are optional.

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* 17. Address

Name

Email Address

Phone Number

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* 18. Gender Identity/Age

	under 18 years	18-30 years	31-45 years	46-65 years	66 years and over
Male	Male under 18 years	Male 18-30 years	Male 31-45 years	Male 46-65 years	Male 66 years and over
Female	Female under 18 years	Female 18-30 years	Female 31-45 years	Female 46-65 years	Female 66 years and over

If you have additional information or concerns please feel free to contact :
Director of the Laboratory Department
816-629-2767