Catholic Health System
Emergency Department
Customer Satisfaction Survey

 


Please take a moment to let us know how we did. Your comments allow us to improve our service.
Your response will be confidential.
 

 
    Which emergency department did you visit?         
 

 
    Date of your visit:         Time of your visit:    


    Who is completing this survey?       Patient             Family member          Friend
 
    Was this your first visit to a Catholic Health System emergency department?
               Yes                  No
 
    Do you know the name of your Doctor or Physician Assistant (PA)?     Yes          No
   
            If yes, please enter his/her name   
                    
 
  1.   My doctor/PA saw me quickly.
   Strongly agree       Agree       Disagree        Strongly disagree       Not applicable
 
   2.   My doctor/PA introduced him/herself.            Yes          No 
 
   3.   My doctor/PA was professional and courteous.
    Strongly agree      Agree      Disagree         Strongly disagree      Not applicable
 
   4.  My nurse, x-ray, lab and other staff was professional and courteous.
    Strongly agree     Agree    Disagree        Strongly disagree      Not applicable
 
   5.  While waiting for test results, my doctor/PA re-checked me.
    Strongly agree     Agree     Disagree        Strongly disagree      Not applicable
 
   6.  While waiting for test results, my nurse re-checked me
    Strongly agree    Agree     Disagree        Strongly disagree      Not applicable
 
   7.  My doctor/PA explained my care and my test results.
    Strongly agree    Agree     Disagree        Strongly disagree      Not applicable
 
   8.  My doctor/PA gave me clear instructions before discharging me from the emergency
        department.
    Strongly agree    Agree     Disagree        Strongly disagree      Not applicable
 
   9.  I was very satisfied with the doctor/PA service.
    Strongly agree    Agree      Disagree       Strongly disagree      Not applicable
 
  10.  I would return to this emergency department for medical care.
    Strongly agree    Agree     Disagree        Strongly disagree       Not applicable
 
   Please feel free to add your comments  
 

               
                               Thank you for helping us get better.