Your answers to the following questions will be an important part of the quality assurance process for our hospital. Please take a few minutes to complete this form. We are asking you to “rate” your recent experience at our hospital by circling your level of satisfaction with various services provided throughout your inpatient stay. If you did not receive specific services mentioned, simply circle the number “6” for NA (not applicable).
I. Hospital Emergency Room/Department Ratings (please skip to item II if you were not admitted through the ER)
Circle the number that most closely approximates your experience in the ER