Patient Survey

In general, what is the quality of your health? (required)

Outstanding

Good

Some Chronic Issues

Poor

How would you rate our concern for your privacy? (required)

How often have you visited RDH within the past year? (required)

First Visit

2-5 Visits

More Than 6

If you were seeking a referral to a specialist, was your request handled in a timely manner? (required)

Yes

No

N/A

Which department did you visit? (required)

How would you rate the competence of the nurse who helped you? (required)

How would you characterize the concern shown to you by the nurse? (required)

Did the nurse respond to you within a reasonable period of time? (required)

Yes

No

Were you able to see the doctor of your choice? (required)

Yes

No

N/A

Were you able to see the doctor of your choice? (required)

Yes

No

N/A

Mark the boxes that characterize the demeanor of your doctor (required)

How would you rate the competence of your doctor? (required)

Did you feel that your doctor's exam was thorough? (required)

Yes

No

N/A

Please rate the clarity of your doctor's explanation of your condition and treatment options? (required)

How well did your doctor include you in your healthcare decisions? (required)

Were your questions answered to your satisfaction? (required)

Yes

No

N/A

If you needed an appointment, did you have to wait longer than expected? (required)

Yes

No

How easy was it to make an appointment by telephone? (required)

Very Easy

Moderately Easy

Very Difficult

How long did you wait to speak to a scheduling staff member? (required)

0 to 2minutes

3 to 5minutes

5 to 7minutes

Longer

Was the person who scheduled your appointment courteous and helpful? (required)

Very Courteous

Moderately Courteous

Rude

How would you rate the courtesy of the staff at the reseption desk? (required)

Very Courteous

Moderately Courteous

Rude

How long did you wait in the reception area beyond your appointment time? (required)

0 to 5minutes

5 to 20minutes

20 to 40minutes

Longer

How long did you wait in the exam room before you saw your physician? (required)

0 to 5minutes

5 to 20minutes

20 to 40mintues

Longer

How would you rate the professionalism and competence of the lab tech who took your blood? (required)

How long did you have to wait to speak to a lab tech? (required)

0-2minutes

3-5minutes

5-7minutes

Longer

How would you rate your level of satisfaction with our business office staff? (required)

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

How would you rate the helpfulness of the business office staff? (required)

Very Helpful

Helpful

Not Helpful

Indifferent

If you had an issue with your bill, did you feel that you received the necessary help to resolve your issue? (required)

Yes

No

How would you rate your overall experience in dealing with the hospital staff and services? (required)

Please list any areas in which our services could be improved. (required)

Please share any additional comments you may have. (required)

First Name (required)

Last Name (required)

Address (required)

City (required)

Telephone (required)

Would you like some one to contact you? (required)

Yes

No

Hospital Survey: How are we doing?

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