NICU Treatment Survey
Please share your feedback about your experience with the Neonatal Intensive Care Unit (NICU) treatment and care. Your responses will help us improve our services.
Your Name (optional)
Relationship to the Patient
*
Please Select
Mother
Father
Guardian
Other
Patient Admission Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient Discharge Date (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall, how satisfied were you with the NICU care your child received?
*
1
2
3
4
5
Please rate the following aspects of the NICU experience.
*
Rows
Excellent
Good
Average
Poor
Medical care provided
1
2
3
4
Communication with doctors
5
6
7
8
Communication with nurses
9
10
11
12
Cleanliness of the facility
13
14
15
16
Support for family members
17
18
19
20
How would you rate the professionalism and compassion of the NICU staff?
*
Not at all professional/compassionate
1
2
3
4
5
6
7
8
9
Extremely professional/compassionate
10
1 is Not at all professional/compassionate, 10 is Extremely professional/compassionate
Were you adequately informed about your child's treatment plan and progress?
*
Yes, always
Sometimes
No, rarely
Did you feel your questions and concerns were addressed promptly?
*
Yes, always
Sometimes
No, rarely
What aspects of the NICU care did you find most helpful?
What improvements would you suggest for the NICU?
Would you recommend our NICU to other families?
*
Yes
No
Submit Survey
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