PHV MEDICAL SURVEY - https://www.pacificahospital.com

PATIENT SATISFACTION SURVEY

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your participation.

PERSONAL DETAILS

Name (optional)

Phone # (optional)

QUALITY OF MEDICAL CARE

Rate the following aspects of your care on a scale from 1 (Very Unsatisfied) to 5 (Very Satisfied)

Likert Scale

	1	2	3	4	5
Were you told how long you would have to wait before being examined by a provider?	1Were you told how long you would have to wait before being examined by a provider? 1	2Were you told how long you would have to wait before being examined by a provider? 2	3Were you told how long you would have to wait before being examined by a provider? 3	4Were you told how long you would have to wait before being examined by a provider? 4	5Were you told how long you would have to wait before being examined by a provider? 5
How well were you kept informed about the delays impacting your care?	1How well were you kept informed about the delays impacting your care? 1	2How well were you kept informed about the delays impacting your care? 2	3How well were you kept informed about the delays impacting your care? 3	4How well were you kept informed about the delays impacting your care? 4	5How well were you kept informed about the delays impacting your care? 5
The waiting room and the treatment areas were clean and comfortable?	1The waiting room and the treatment areas were clean and comfortable? 1	2The waiting room and the treatment areas were clean and comfortable? 2	3The waiting room and the treatment areas were clean and comfortable? 3	4The waiting room and the treatment areas were clean and comfortable? 4	5The waiting room and the treatment areas were clean and comfortable? 5
Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation?	1Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation? 1	2Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation? 2	3Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation? 3	4Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation? 4	5Nursing staff communicated with respect and courtesy, actively listening and providing clear explanation? 5
The Physician communicated all information and treatment plans clearly?	1The Physician communicated all information and treatment plans clearly? 1	2The Physician communicated all information and treatment plans clearly? 2	3The Physician communicated all information and treatment plans clearly? 3	4The Physician communicated all information and treatment plans clearly? 4	5The Physician communicated all information and treatment plans clearly? 5
Medication details and instructions were clearly explained?	1Medication details and instructions were clearly explained? 1	2Medication details and instructions were clearly explained? 2	3Medication details and instructions were clearly explained? 3	4Medication details and instructions were clearly explained? 4	5Medication details and instructions were clearly explained? 5
Received appropriate assistance for mobility and using the bathroom upon request?	1Received appropriate assistance for mobility and using the bathroom upon request? 1	2Received appropriate assistance for mobility and using the bathroom upon request? 2	3Received appropriate assistance for mobility and using the bathroom upon request? 3	4Received appropriate assistance for mobility and using the bathroom upon request? 4	5Received appropriate assistance for mobility and using the bathroom upon request? 5
Pleased with the friendliness and professionalism of our staff?	1Pleased with the friendliness and professionalism of our staff? 1	2Pleased with the friendliness and professionalism of our staff? 2	3Pleased with the friendliness and professionalism of our staff? 3	4Pleased with the friendliness and professionalism of our staff? 4	5Pleased with the friendliness and professionalism of our staff? 5
Likelihood to recommend Pacifica Hospital of the Valley to friend and family member?	1Likelihood to recommend Pacifica Hospital of the Valley to friend and family member? 1	2Likelihood to recommend Pacifica Hospital of the Valley to friend and family member? 2	3Likelihood to recommend Pacifica Hospital of the Valley to friend and family member? 3	4Likelihood to recommend Pacifica Hospital of the Valley to friend and family member? 4	5Likelihood to recommend Pacifica Hospital of the Valley to friend and family member? 5
Will choose Pacifica Hospital of the Valley for treatment again?	1Will choose Pacifica Hospital of the Valley for treatment again? 1	2Will choose Pacifica Hospital of the Valley for treatment again? 2	3Will choose Pacifica Hospital of the Valley for treatment again? 3	4Will choose Pacifica Hospital of the Valley for treatment again? 4	5Will choose Pacifica Hospital of the Valley for treatment again? 5

OVERALL EXPERIENCE

ADDITIONAL Rate (optional)

Rate the following on a scale from 1 (Very Unsatisfied) to 5 (Very Satisfied)

Selected Value: 0

ADDITIONAL COMMENTS

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Please share any other comments or suggestions to help us improve our services.

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