Patient Satisfaction Form

Thank you for choosing Mercer County Hospital. We appreciate your confidence and support. MCH strives to meet the health and wellness needs of our community. In order to do so, it is very important to get your feedback. We ask that you please complete the following survey. Your comments will remain confidential.

Survey Instructions

Any information that may identify you or your family will be kept private. Please answer all questions by selecting the answer that best describes your experience. Please complete only those sections that apply to the service you received. Some sections may not apply.

The Following Questions Refer to Registration:

  • Staff treated me promptly, were friendly and willing to help
    Never Sometimes Usually Always N/A

  • Staff were concerned for my privacy
    Never Sometimes Usually Always N/A

The Following Questions Refer to Physician/Doctor:

  • My treatment and test results were explained in a way I could understand.
    Never Sometimes Usually Always N/A

  • The physician listened carefully to me.
    Never Sometimes Usually Always N/A

  • The physician treated me with courtesy and respect.
    Never Sometimes Usually Always N/A

  • Staff respected my privacy.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Nursing/Emergency:

  • Staff treated my family and me with courtesy and respect.
    Never Sometimes Usually Always N/A

  • Staff listened carefully to my concerns and explained things so I could understand.
    Never Sometimes Usually Always N/A

  • Staff did everything they could to help my pain be well controlled.
    Never Sometimes Usually Always N/A

  • Staff talked to me about whether I would need help once I left the hospital and what resources available.
    Never Sometimes Usually Always N/A

  • Staff respected my privacy.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Lab:

  • Staff explained to me in a way I could understand what was expected of me during treatment/test.
    Never Sometimes Usually Always N/A

  • My waiting time was in a reasonable timeframe.
    Never Sometimes Usually Always N/A

  • Staff treated me with respect for my personal privacy and comfort.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Radiology:

  • Staff explained to me in a way I could understand what was expected of me during treatment/test.
    Never Sometimes Usually Always N/A

  • My waiting time was in a reasonable timeframe.
    Never Sometimes Usually Always N/A

  • Staff treated me with respect for my personal privacy and comfort.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Therapy Services:

  • Staff explained to me in a way I could understand what was expected of me during treatment/test.
    Never Sometimes Usually Always N/A

  • My waiting time was in a reasonable timeframe.
    Never Sometimes Usually Always N/A

  • Staff treated me with respect for my personal privacy and comfort.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Support Services (Food Service, Housekeeping, Maintenance):

  • I found the cleanliness of the facility and grounds to be acceptable.
    Never Sometimes Usually Always N/A

  • Staff respected my privacy.
    Never Sometimes Usually Always N/A

  • I found the food to be of good quality.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Cardiopulmonary:

  • Staff explained to me in a way I could understand what was expected of me during treatment/test.
    Never Sometimes Usually Always N/A

  • My waiting time was in a reasonable timeframe.
    Never Sometimes Usually Always N/A

  • Staff treated me with respect for my personal privacy and comfort.
    Never Sometimes Usually Always N/A

The Following Questions Refer to Anesthesia Services:

    The Anesthesia staff adequately explained and prepared me for my anesthetic.
    Never Sometimes Usually Always N/A

  • The Anesthesia staff listened to my concerns as well as discussed options and potential risks for me.
    Never Sometimes Usually Always N/A

  • Staff treated me with respect for my personal privacy and comfort.
    Never Sometimes Usually Always N/A

Other

Comments (Describe good/bad experience):

Name:

Phone number:

E-mail address: