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HIND GENERAL HOSPITAL
 
Patient Satisfaction Questionnaire - Out Patient
 
 
Dear Hind Hospital Client: We are pleased that you and your Doctor chose HGH for your outpatient procedure. We hope that your stay with us was comfortable and pleasant. Our goal is to provide high quality medical care to our patients and their family members. That is why we invite your response to this questionnaire. With your help, the staff can evaluate how effectively we are meeting the challenge of providing you with quality health care. Your comments and response will be thoroughly reviewed and kept strictly confidential unless you specify otherwise.
 
Thank you for your comments,
Hind General Hospital
 
Date of Surgery or Procedure:   - -
 
Please give us your confidential opinion…..
 
Excellent Good Fair Poor Very Poor      
5 4 3 2     1    
     
            5 4 3 2 1
1. What was your general impression of the Hospital?  
     
2. How would you rate the Admitting office staff?
a) Prompt  
b) Efficient  
c) Courteous  
d) Concerned  
e) Did they give adequate explanations/directions  
f) Did they provide adequate explanation of billing procedure?  

   
3. How would you rate the facility?
a) Clean  
b) Comfortable  
c) General Atmosphere  
d) Convenience/ Accessibility  
     
4. How would you rate the Anesthetic practitioner who provided your anesthesia care?
a) Prompt  
b) Courteous  
c) Skill  
d) Did they give you adequate explanations and directions?
  
     
5.How would you rate the nursing staff in the recovery room?
a) Prompt  
b) Efficient  
c) Courteous  
d) Concerned  
e) Did they explain post operative instructions well?  
     
6. Would you return to Hind General Hospital should you require further health care services?   Yes No
     
7. Would you be willing to refer a family member or friend for treatment?
   Yes No
     
8. Was this your first visit to our hospital?
   Yes No
     
  HGH offers Physician Refferal Service. Would you like information on an appointment for any of the following? Please indicate which service and a counselor will be happy to contact you.   Cosmetic Services
  Chiropractic Services
  Dental Services
  Gastroenterology Services
  General Surgery Services
  Internal Medicine
  Obstetrics and Gynecology Services
  Ophthalmology Services
  Oral Surgery Services
  Orthopedic Services
  Pain Management Services
  Podiatry Services
  Urology Services
   
  Optional and Confidential  
     
  Name:
     
  Address:
     
  City:
     
  State:
     
  Zip Code:
     
  Phone: - -
     
 
 
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