1. The comfort and cleanliness of your room

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

2. The comfort and cleanliness of your bed

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

3. The convenience and cleanliness of your bathroom

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

4. The noise level in and around your room

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

5. Your comfort level using the common areas (such as family room or play room)

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

6. The availability of and usefulness of computers

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

7. The availability of and access to outdoor areas

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

8. The availability of the kitchen and equipment you needed to prepare your own meals (ex. pot, pan, utensils)

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

9. Availability of meals prepared by others (ex. volunteers or house staff)

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

10. Availability of laundry services

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

11. Availability of transportation

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

12. Availability of activities for you and your family

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

13. The helpfulness of and friendliness of the staff

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

14. The helpfulness and friendliness of the volunteers

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

15. Respect from staff of your culture

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

16. Availability of support services at the House (ex. social workers, emotional support)

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

17. Rate your overall experience at the Ronald McDonald House

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

18. Please list any serivces which are important to you that we are NOT providing.

19. Please list any comments you may have about the environment at the Ronald McDonald House

20. Ease of the referral process

  Very Complicated Complicated Average Easy Very Easy N/A
Importance
Your Experience

21. Ease of the check in process

  Very Complicated Complicated Average Easy Very Easy N/A
Importance
Your Experience

22. Ease of the check out process

  Very Complicated Complicated Average Easy Very Easy N/A
Importance
Your Experience

23. Respect for your privacy

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

24. Explanation of House procedures upon arrival

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

25. Request for payment of House fees

  Very Poor Poor Average Good Very Good N/A
Importance
Your Experience

26. What comments do you have regarding the Ronald McDonald House procedures?

27. Because of the Ronald McDonald House, I was better able to rest and maintain my physical well-being while my child was receiving medical care.

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

28. While staying at the Ronald McDonald House, I felt emotionally supported from other families, staff, and volunteers

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

29. I was able to access information about my child's condition while at the Ronald McDonald House (ex. computer access, phones, resource library, other families)

  Strongly Disagree Disgree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

30. My ability to stay close by improved my child's experience at the hospital

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

31. My ability to stay close by improved my child's recovery at the hospital

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

32. I was better able to follow my child's doctor's recommendations because we were able to stay close to the hosptial and my child

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

33. The Ronald McDonald House helped my family stay together during a very difficult time

  Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree N/A
Your Experience

34. Please share any comments you may have on the impact the Ronald McDonald House had on your family

35. Was this your first stay at the Ronald McDonald House?

36. How did we accomodate you during your stay?

37. What was your room number at the Ronald McDonald House?
Check all that apply

38. How many people stayed in your room?

39. Was your whole (immediate) family together during your stay?

40. Was your patient child:

41. What was the name of your patient child's disease or condition?

42. What is your patient child's age?

43. What is your relationship to the patient child?

44. During your stay, which hospital has been treating your child?

45. What hospital department was your child in?

46. How did you first hear about staying at the Ronald McDonald House?

47. How long did you stay at the Ronald McDonald House/hotel in total?

48. How would you identify your race/ethnicity (optional)

49. Is English the primary language spoken in your home?

50. What is your email address? (optional)

51. Thank you for sharing your opinion. Is there anything else you would like to share with us about your experience at the Ronald McDonald House?

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