Emergent Medical Associates - The Hands that Heal

Patient Satisfaction Survey

Providing excellent service is important to us. Please take a moment to complete the following survey.

General Questions

Which Hospital did you visit?

Date of visit

Approximate time you spent in the Emergency Department?

Did you arrive by ambulance?

Yes No

Was this you first visit to the above Emergency Department?

Yes No

How did you find out about the above Emergency Department?

Did your visit to the Emergency Department lead to admission into the hospital?

Yes No

Reception / Waiting Area

Was the reception / waiting area comfortable & clean?

Excellent Good Poor N/A

Was there adequate reading material in the reception/waiting area?

Excellent Good Poor N/A

Length of time waiting before nursing evaluation (Minutes)?

Registration / Admission

Was the registration person courteous?

Excellent Good Poor N/A

Were the billing & credit policies explained to you?

Excellent Good Poor N/A

Were procedures explained to you?

Excellent Good Poor N/A

Length of time waiting before brought to treatment area (Minutes)?

Medical Services

Was your nurse professional, courteous and attentive?

Excellent Good Poor N/A

Was your nurse efficient and did he / she make you feel comfortable?

Excellent Good Poor N/A

Was the Emergency Dept. physician professional, courteous and attentive?

Excellent Good Poor N/A

Was the ED physician efficient and did he / she make you feel comfortable?

Excellent Good Poor N/A

Was the Emergency Dept. physician prompt?

Excellent Good Poor N/A

Were all procedures explained to your satisfaction?

Excellent Good Poor N/A

Did the physician explain your condition / diagnosis to you?

Excellent Good Poor N/A

Were your aftercare instructions reviewed with you?

Excellent Good Poor N/A

Did you understand your aftercare instructions?

Excellent Good Poor N/A

Radiology (x-ray) & Laboratory Dept. (if used):

Were your X-Rays and / or lab work completely promptly?

Excellent Good Poor N/A

Were the staff members professional & courteous?

Excellent Good Poor N/A

Radiology (x-ray) & Laboratory Dept. (if used):

Were your X-Rays and / or lab work completely promptly?

Excellent Good Poor N/A

Were the staff members professional & courteous?

Excellent Good Poor N/A

Family & Friends (If you came alone, skip this section):

Were your family or friends treated with courtesy?

Excellent Good Poor N/A

Did the staff keep your family / friends informed about your treatment?

Excellent Good Poor N/A

Did the staff allow your family / friends to be with you during your treatment?

Excellent Good Poor N/A

Some Final Ratings

Were you kept informed about delays, if any, in the Emergency Dept.?

Excellent Good Poor N/A

Was your overall treatment in the Emergency Dept. satisfactory?

Excellent Good Poor N/A

Would you recommend the Emergency Dept. to your family / friends?

Excellent Good Poor N/A

Was the Emergency Dept. easy to locate?

Excellent Good Poor N/A

Were the parking facilities adequate?

Excellent Good Poor N/A

Was the signage clear?

Excellent Good Poor N/A

What can we do to improve our Emergency Dept. services?

Overall Impressions / Comment:

Optional Information

Your Name

Telephone No.

Address

City

State

Zip

Referring Physician

Emergent Medical Associates : Turn to the hands that heal

Patient Satisfaction Survey

General Questions

Reception / Waiting Area

Registration / Admission

Medical Services

Radiology (x-ray) & Laboratory Dept. (if used):

Radiology (x-ray) & Laboratory Dept. (if used):

Family & Friends (If you came alone, skip this section):

Some Final Ratings

Optional Information