Patient Satisfaction Survey

1. What service(s) did you receive while at Mark Reed?

• Clinic
• Lab
• Radiology
• Emergency
• Inpatient

2. Admission/Registration

Space Cell	Always	Mostly	Sometimes	Not at All
During this visit, how often did the registration staff treat you with courtesy and respect?	Always	Mostly	Sometimes	Not at All
During this visit, how often did registration staff listen carefully to you?	Always	Mostly	Sometimes	Not at All

3. Admission/Registration

During this visit how much time did you spend waiting for admission/registration?

• Less than expected
• As expected
• More than expected

4. Physician's Care

• I did not see a physician during this visit (Please go to Question 6)

5. Physician's Care

Space Cell	Always	Mostly	Sometimes	Not at All	Not Applicable
During this visit, how often did the physician treat you with courtesy and respect?	Always	Mostly	Sometimes	Not at All	Not Applicable
During this visit, how often did the physician listen carefully to you?	Always	Mostly	Sometimes	Not at All	Not Applicable
During this visit, did the physician explain your condition and treatment in a way that you could understand?	Always	Mostly	Sometimes	Not at All	Not Applicable
During this visit, was your pain well controlled?	Always	Mostly	Sometimes	Not at All	Not Applicable

6. Nurse's Care

• I did not see a nurse during this visit (Please go to Question 8)

7. Nurse's Care

Space Cell	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit
During this visit, how often did the nursing staff treat you with courtesy and respect?	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit
During this visit, how often did nursing staff listen carefully to you?	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit
During this visit, did the nursing staff explain your condition and treatment in a way you could understand?	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit
During this visit, after you pressed the call button, how often did you get help as soon as you wanted it?	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit
During your visit how often did the nursing staff respond to your personal needs?	Always	Mostly	Sometimes	Not at all	I did not use a call button during this visit

8. Laboratory

• I did not have laboratory services during this visit (Please go to Question 10)

9. Laboratory

Space Cell	Always	Mostly	Sometimes	Not at all
During this visit, how often did the laboratory staff treat you with courtesy and respect?	Always	Mostly	Sometimes	Not at all
During this visit, did the laboratory staff collect your specimen with skill accuracy and a minimum of discomfort?	Always	Mostly	Sometimes	Not at all

10. X-Ray/Radiology

• I did not have x-ray service during this visit (Please go to Question 12)

11. X-Ray/Radiology

Space Cell	Always	Mostly	Sometimes	Not at all
During this visit, how often did the x-ray staff treat you with courtesy and respect?	Always	Mostly	Sometimes	Not at all
During this visit, did the radiology staff collect your specimen with skill accuracy and a minimum of discomfort?	Always	Mostly	Sometimes	Not at all

12. Hospital Experience

• I did not stay in the hospital overnight (Please go to Question 14)

13. Hospital Experience

Space Cell	Always	Mostly	Sometimes	Not at all
During your hospital stay, was your room and bathroom kept clean?	Always	Mostly	Sometimes	Not at all
If you stayed overnight, was the area around your room quiet?	Always	Mostly	Sometimes	Not at all

14. Rating/Recommendations

Using a number from 1 to 5, where 1 is the worst possible experience and 5 is the best possible experience, what number would you use to rate Mark Reed Health Care District?

• 5
• 4
• 3
• 2
• 1

15. Rating/Recommendations

Would you recommend Mark Reed Health Care District to your friends and family?

• Definately Yes
• Probably Yes
• Probably No
• Definately No