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* 1. What was your overall opinion of our Emergency Department?

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* 2. Would you choose our Emergency Department again?

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* 3. Would you recommend this emergency department to your friends and family?

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

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* 5. Your first greeting upon arrival was:

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* 6. The availability and friendliness of the ER registration clerk was:

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* 7. The amount of time to be seen by a nurse was:

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* 8. The time that it took you to be seen by a doctor was:

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* 9. The manner with which the doctor took your problems seriously was:

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* 10. The explanation of test(s) and treatment by the staff was:

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* 11. I received a copy of my written discharge instructions.

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* 12. The cleanliness and comfort of the Emergency Department was:

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* 13. Your pain was adequately treated.

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* 14. The emergency department staff maintained your privacy.

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* 15. Adequate precautions were taken for your safety.

Radiology

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* 16. The staff in the X-Ray department was compassionate and caring.

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* 17. The amount of time it took to perform your tests was:

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* 18. X-Ray procedures were fully explained by the staff.

Laboratory

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* 19. The staff in the Laboratory department was compassionate and caring. 

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* 20. The time it took to perform Lab tests was:

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* 21. Lab procedures were fully explained by the staff.

Respiratory/EKG

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* 22. The staff in the Respiratory/EKG department was compassionate and caring.

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* 23. The time it took to perform your test(s) were:

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* 24. Respiratory/EKG procedures were fully explained by the staff.

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* 25. What one thing could we do that would most improve your ER experience?

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* 26. Other comments.

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* 27. Date of visit (optional)

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* 28. Contact information (optional)

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* 29. Gender Identity (optional)

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* 30. Age (optional)

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

If you have additional information or concerns please feel free to contact:

Director of Med./Surg./ED

816-629-3638
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