Pineville Community Hospital : Patient Satisfaction Survey

Patient Satisfaction Survey

Name (optional):

Date of Service:

Type of Service:

In-patient

Out-patient

ER Visit

Surgery

(Select all that apply)

Dear Patient;

All of us at Pineville Community Hospital are constantly seeking to improve our services to you and the community. We ask that you take a few minutes to complete this survey. Your comments are confidential. We welcome any suggestions or comments that you have concerning the quality of care you received.

EX = Excellent GD = Good AV = Average NI = Needs Improvement

	EX	GD	AV	NI
In general, how do you rate our hospital?
How was our Admitting Service?
How were your room accommodations?
Nursing Services: Were the nurses courteous, knowledgeable, and quick to respond to your needs?
I felt that my safety was important to my doctor and PCH.
Were your take home instructions clear and concise?
I was educated about my illness, treatments and plan of care.
How were these services, if applicable?
Laboratory?
Cardiopulmonary?
Radiology?
Physical Therapy?

Dietary Services: How was your food and meal service?

Housekeeping and Maintenance: Were things clean and in working order?

Business Office arrangements and services.
Social Service and Discharge Planning.

Rate our treatment of your visitors.

Do you have any comments regarding the safety of your hospital experience?


Thank you for your assistance. If you wish to have our Patient Representative contact you, please list your phone number and best time to call.
Phone number:
Best time to call:

Do you have any suggestions for services that we do not currently offer?


Do you or your family presently travel outside the Pineville area to seek medical care?			Yes	No
If yes, please check reason:
Physician Specialist (please include type of specialist)
Service (please include type of service)
Other (please specify)

Do you see a need for additional physicians?			Yes	No

How can PCH be of greater value to you and your family?


Any additional comments:


We appreciate and value your time and cooperation in filling out this questionnaire.