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PATIENT SATISFACTION SURVEY Print

Apollo Behavioral Health Hospital, LLC
Patient/Family Satisfication Survey
Name of person completing form :       

Date:

Patient Name (opt) :

In order to improve the quality of our hospital and to help us meet the needs of our patients, we would like your feedback. Your opinion is valued and we appreciate you taking the time to give us feedback on our hospital.

Staff and Guest Relations

1 Level of courtesy shown by staff to patient, family and visitors.
 NA Poor Fair Good Very Good Excellent
2 Willingness of Psychiatrist to respond to the patient's needs.
 NA Poor Fair Good Very Good Excellent
3 Willingness of Medical Doctor to respond to the patients needs.
 NA Poor Fair Good Very Good Excellent
4 Willingness of Nursing staff to respond to the patients needs.
 NA Poor Fair Good Very Good Excellent
5 Willingness of the Social Worker to respond to the patient's needs.
 NA Poor Fair Good Very Good Excellent
6 Willingness of Recreational Therapist to respond to the patient's needs.
 NA Poor Fair Good Very Good Excellent
7 How well staff understood the patient's needs and problems.
 NA Poor Fair Good Very Good Excellent

Hospital Treatment

8 Staff assistance in helping the patient assume responsibility for meeting their treatment goals.
 NA Poor Fair Good Very Good Excellent
9 How well did the staff explain the reason(s) for the patient's admission?
 NA Poor Fair Good Very Good Excellent
10 How well were the program rules and patient rights explained?
 NA Poor Fair Good Very Good Excellent
11 Satisfaction that program rules and policies were enforced fairly.
 NA Poor Fair Good Very Good Excellent
12 Satisfaction with the nurses explanation for medications and possible side effects.
 NA Poor Fair Good Very Good Excellent

Discharge Instructions

13 Staff discussion with patient and or family regarding discharge. plan
 NA Poor Fair Good Very Good Excellent
14 Rate the quality of care and services the patient received.
 NA Poor Fair Good Very Good Excellent
15 Discharge instructions were explained in full to the patient and or family for further treatment, medications, follow-up appointments, and possible adverse reactions to medications and after inpatient treatment is no longer available.
 NA Poor Fair Good Very Good Excellent
16 How much do you feel you stay at the APOLLO BHH helped you?
 NA Poor Fair Good Very Good Excellent

Meals, Rooms, and Housekeeping

17 Were you satisfied with the meals and snacks you received during your stay?
 NA Poor Fair Good Very Good Excellent
18 Were you satisfied with the promptness that you received your meals and snacks?:
 NA Poor Fair Good Very Good Excellent
19 Were you satisfied with the temperature in your room?
 NA Poor Fair Good Very Good Excellent
20 Were you satisfied with the cleanliness of your hospital room during your stay.
 NA Poor Fair Good Very Good Excellent

Overall Rating of Hospital Services

21 How would you rate the overall services received during your stay?
 NA Poor Fair Good Very Good Excellent
   

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