Thank you for using the Outpatient 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. Please indicate the clinic in which you were seen:

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* 2. What was your overall opinion of the Outpatient Department?

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* 3. Would you choose our Outpatient Department again?

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* 4. Would you recommend our Outpatient Department to your family and friends?

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* 5. The ease and convenience of scheduling your appointment was:

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* 6. When scheduling your appointment, how often was the scheduler polite and respectful?

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* 7. After the registration process, your wait time to be seen by a nurse was:

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* 8. After being seen by a nurse, your wait time to be seen by your doctor was:

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* 9. During your visit in the Outpatient Department, how often did nurses treat you with courtesy and respect?

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* 10. During your visit in the Outpatient Department, how often did nurses listen carefully to you?

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* 11. During your visit in the Outpatient Department, how often did nurses explain things in a way you could understand?

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* 12. During your visit in the Outpatient Department, how often did your doctor treat you with courtesy and respect?

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* 13. During your visit in the Outpatient Department, how often did your doctor listen carefully to you?

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* 14. During your visit in the Outpatient Department, how often did your doctor explain things in a way you could understand?

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* 15. The cleanliness and comfort of the Outpatient Department was:

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* 16. Adequate precautions were taken for your safety:

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* 17. During your visit in the Outpatient Department, how often did staff maintain your privacy?

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* 18. Please rate the services you received from the following departments:

  Excellent Very Good Good Fair Poor N/A
Admitting/Registration
Laboratory
Radiology
Cardiopulmonary

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* 19. What one thing could we do that would improve your outpatient experience?

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* 20. Other comments:

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* 21. Date of visit (optional)

Date / Time

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* 22. Contact information (optional)

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* 23. Gender identity (optional)

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* 24. Age (optional)

T