Hospital Community Relations Survey
Help us improve by sharing your experiences and opinions about our hospital's role in the community.
What is your relationship to our hospital?
*
Patient
Family member of a patient
Hospital staff
Community resident
Other
How would you rate your overall satisfaction with our hospital?
*
1
2
3
4
5
Which hospital services have you or your family used in the past 12 months? (Select all that apply)
*
Emergency care
Outpatient services
Inpatient care
Community outreach programs
None
Other
How well do you feel the hospital communicates with the community?
*
Very well
Well
Average
Poorly
Very poorly
What do you think the hospital could do to strengthen its relationship with the community?
Do you have any additional comments or suggestions for us?
What is your age group?
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
Submit Survey
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