Emergency Department Patient Satisfaction Survey

Patient Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Date Visited Emergency Department

Date

Diagnosis

1. Nurses gave importance to my treatment.

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

3. Nurses was patient during my treatment.

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

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

6. I was treated kindly by the admission staff.

7. The emergency room was tidy and quiet.

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

9. The hygiene of the emergency room was satisfying.

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

11. I was treated kindly by the physician.

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

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

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

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

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

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

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

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

Emergency Department Staff