Los Robles Emergency Department Satisfaction Survey

The Los Robles Emergency Department is committed to making sure that you were very satisfied with your visit with us. We value your opinion and feedback in order to continue to improve our services. After completing our brief questionnaire you will also have the opportunity to add any additional comments about your experience.

Were you admitted to the hospital or discharged home?

Admitted to the hospital or transferred to another hospital

Discharged Home

Please enter your Account Number as it appears on your aftercare instruction sheet. It starts with G00 - followed by 9 digits.

Please indicate your level of satisfaction with the following aspects of your visit to the Los Robles Emergency Department:

Which nurses took care of you? (select all that apply)

Please evaluate your nursing care

The name of the Emergency Physician who provided care
(as listed on your aftercare instructions)

Please evaluate your Emergency Physician

This survey has been completed by:

The patient

Family of the patient

Friend of the patient

Patient's caregiver

Please provide any additional comments which you feel would be useful to us

You may optionally leave your contact information:

First Name :
Last Name :
Phone :
Email Address :

You may receive a telephone survey asking some of the same questions that you just answered. The telephone survey is conducted by Gallup and unrelated to this survey which was developed as a process improvement tool. We hope that your visit to our Emergency Department was very satisfactory.

Patient Satisfaction