Emergency Department Patient Satisfaction Survey

Patient Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email Address

example@example.com

Date Visited Emergency Department

Date

Diagnosis

1. Nurses gave importance to my treatment.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

2. I was informed about my treatment process by nurses.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

3. Nurses was patient during my treatment.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

4. Nurses gave a lot of effort to stop my pain.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

5. Admission staff was informative to me during the visit.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

6. I was treated kindly by the admission staff.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

7. The emergency room was tidy and quiet.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

8. Equipments in the emergency room was in good condition.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

9. The hygiene of the emergency room was satisfying.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

10. I was informed by the physician about my treatment process.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

11. I was treated kindly by the physician.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

12. I understood the explanations that the physician told me about my treatment.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

13. The examination time of the physician was long enough.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

14. I didn't wait too long before the physician examining me.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

15. I didn't wait too long before the admission process.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

16. I am satisfied with the quality of emergency services of this hospital.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

17. I would recommend the emergency department of this hospital.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

18. My family was treated kindly by the emergency department staff.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

19. My family could see me for a proper amount of time.

Totally agreeSomewhat agreeSomewhat disagreeTotally disagree

Emergency Department Patient Satisfaction Survey

Emergency Department Staff

Emergency Department Room

Physician Care Satisfaction

Patient Satisfaction

Patient's Family Satisfaction