Thursday, August 28, 2008

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Outpatient Satisfaction Survey

Department - Most Recent Treatment
Please indicate the department of service from your last outpatient visit.
Radiology	Lab	Cardiopulmonary
Cath Lab / Infusion Clinic	Physical Therapy	Outpatient Surgery
Heart Works	Oncology Suite
Other



Department - General Patient Information
What was the date of your last visit?
Was this your first time with us as an outpatient? Yes No



Department - Registration Process
Efficiency of registration procedure:The ease of getting registered, including the amount of time it took.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Courtesy of personel: The courtesy and friendliness of the registration personnel.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Ease of checking into clinical department.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

From the time you checked in, the length of time it took to be called for your treatment or test.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied



Facility
Condition of treatment area: The condition of the area where your treatment was given, including cleanliness, temperature and appearance.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Safety and Security: How safe and secure the hospital staff made you feel.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied



General Procedure
General instructions: How well staff explained tests, treatments and what to expect.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Ease of getting information: Willingness of hospital staff to answer your questions.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Teamwork: Coordination and teamwork of all the staff that took care of you.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Skill of staff: How well things were done, performing tests, drawing blood, etc.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Concern and caring by staff: Courtesy and respect you were given; friendliness and kindness.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied



General Overview
Overall Quality: Overall quality of care and services you received during your visit to O'Bleness Memorial Hospital.
Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied

Recommendations: Would you recommend this hospital to others if they need tests or treatments?
Always	Usually	Sometimes	Never

General Information

Name: (Optional)

Phone number: (Optional)

Would you like to be contacted? Yes No

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