In an effort to continually provide the best service to out patients, we are asking you to complete this survey. Your input and feedback will help us to continue to improve upon the care we bring pour patients.

Admitting / Registration

Professional & Courteous Service
ExcellentGoodNeeds Improvement

Speed & Efficiency of Registration
ExcellentGoodNeeds Improvement

Satisfactory Answers to Questions
ExcellentGoodNeeds Improvement

Nursing

Professional & Courteous Service
ExcellentGoodNeeds Improvement

Nurses Introduced Themselves & Kept You Informed
ExcellentGoodNeeds Improvement

Satisfactory Answers to Questions
ExcellentGoodNeeds Improvement

Written Instructions for Home Care
ExcellentGoodNeeds Improvement

Overall

Staff Gave You Privacy
ExcellentGoodNeeds Improvement

Cleanliness & Comfort of Care
ExcellentGoodNeeds Improvement

Likelihood You Would Return or Recommend Our Center
ExcellentGoodNeeds Improvement

Overall Rating of Your Experience
ExcellentGoodNeeds Improvement

Additional Comments

Name (Optional)