This free survey is powered by
0%
Exit Survey
 
 
Patient's Name
   
 
 
 
Room #
   
 
 
 
Date:
   
Length of stay:
   
 
 
 
Do you know who is taking care of you?
 
Yes
 
No
 
 
 
Do you find our staff courteous?
 
Yes
 
Sometimes
 
No
 
 
 
Do you understand why you are here and the medications which are prescribed?
 
Yes
 
No
 
 
 
Are you kept informed of new medications, procedures, delays, etc?
 
Yes
 
No
 
 
 
Do you receive the help that you need when you ask for it?
 
Yes
 
No
 
Sometimes
 
 
 
Are staff managing your pain?
 
Yes
 
No
 
N/A
 
 
 
How would you rate your hospital stay so far?
 
Excellent
 
Good
 
Fair
 
Poor
 
Share This Survey:          Surveys Powered by  QuestionPro Survey Software