Family Survey

 


Your opinion is important to us.

We strive to provide the best care we can and want your stay with us to be as comfortable as possible. Your responses to this survey are anonymous and will only be used to improve our unit for future patients and families.

Please have one family member complete the survey.  Give your honest opinion for each statement.  Click the answer that best describes how satisfied you are with the care that your and your family member received while in the critical care unit.

When finished, click the submit button at the bottom of the page.  Submit the form only once and wait for the confirmation page to appear.  This may take a moment. Thank you for your participation.

 
Hospital : (Please select your hospital from drop down menu)
Unit :
#1 Are you satisfied with our staff's honesty about your loved one's condition?
 
   
#2 Are you satisfied with our doctors' availability to speak about your loved one's condition?
 
   
#3 Are you satisfied with the waiting time for results of tests and x-rays?
 
   
#4 Are you satisfied with your peace of mind in knowing your loved one's nurse(s)?
 
   
#5 Are you satisfied with your ability to share in the care of your loved one?
 
   
#6 Are you satisfied with our explanation of tests, procedures and treatments?
 
   
#7 Are you satisfied with the promptness of our staff in responding to alarms and requests for assistance?
 
   
#8 Are you satisfied with the cleanliness and appearance of the waiting room?
 
   
#9 Are you satisfied with the support and encouragement given to you during your loved one's stay in the critical care unit?
 
   
#10 Do you receive clear answers to the questions you ask?
 
   
#11 Are you satisfied with the quality of care given to your loved one?
 
   
#12 Are you satisfied with your ability to share in decisions regarding your loved one's care on a regular basis?
 
   
#13 Are you satisfied with our nurses? availability to speak with you every day about your loved one's care?
 
   
#14 Are you satisfied with our doctors' sensitivity to your loved one's needs?
 
   
#15 Are you satisfied with the privacy provided to you and your family members during visits?
 
   
#16 Are you satisfied with the preparation of your loved one for transfer from the critical care unit?
 
   
#17 Are you satisfied with the peacefulness of the waiting room?
 
   
#18 Are you satisfied with our visiting hours?
 
   
#19 Are you satisfied with the level of noise in the critical care unit?
 
   
#20 Are you satisfied with your ability to share in discussions about your loved one's recovery?
 
   
#21 What is your relationship to the patient?
 
   
#22 What is your age?
 
   
#23 What is the number of days your loved one is/was in the critical care unit?
 
   
#24 What is the age of your loved one?
 
   
#25 Is your loved one male or female?
 
   
#26 Are you male or female?