SERVICES RECEIVED

Which services did you utilize on your most recent outpatient visit? (Check all that apply)

Emergency Services/Urgent Care
Endoscopy
Financial Counseling
Imaging Services (CT scanning, ultrasound, nuclear medicine, MRI)
Laboratory Testing
Lactation Services
Mammography
Massage Therapy
Nutrition Counseling
Outpatient IV Therapy
Outpatient Maternity Services
Physical Therapy
Respiratory Services
Same Day Services
Sleep Center
Social Services
Travel Clinic
Other Outpatient Service:

PRE-ADMISSION
(9 = Most Satisfied to 1 = least satisfied)

The pre-operative appointment was convenient for me.
9 8 7 6 5 4 3 2 1 NA
I was provided with adequate information and instructions at my
pre-operative appointment.
9 8 7 6 5 4 3 2 1 NA

UPON ARRIVAL
(9 = Most Satisfied to 1 = least satisfied)

Registration was convenient and timely.
9 8 7 6 5 4 3 2 1 NA
The Registration staff was courteous and helpful.
9 8 7 6 5 4 3 2 1 NA
Locating the appropriate department was easy.
9 8 7 6 5 4 3 2 1 NA

OUTPATIENT CARE
(9 = Most Satisfied to 1 = least satisfied)

The hospital was clean, comfortable and quiet.
9 8 7 6 5 4 3 2 1 NA
My personal choices were accommodated to the extent possible.
9 8 7 6 5 4 3 2 1 NA
My care was provided in a timely manner.
9 8 7 6 5 4 3 2 1 NA
Any delays in treatment were explained to me in an acceptable manner.
9 8 7 6 5 4 3 2 1 NA
I was given adequate information and education.
9 8 7 6 5 4 3 2 1 NA
The staff made every effort to ensure my safety.
9 8 7 6 5 4 3 2 1 NA
My cultural, ethnic, and personal preferences were accommodated.
9 8 7 6 5 4 3 2 1 NA
My needs were accommodated to the extent possible.
9 8 7 6 5 4 3 2 1 NA
The needs of my family/friends were accommodated to the extent possible.
9 8 7 6 5 4 3 2 1 NA
The staff made every effort to ensure my privacy.
9 8 7 6 5 4 3 2 1 NA
The staff was skilled and confident.
9 8 7 6 5 4 3 2 1 NA
I was encouraged to participate in my own care.
9 8 7 6 5 4 3 2 1 NA

HEALTHCARE PROVIDER CARE
Please evaluate the healthcare provider (i.e. physician, R.N., radiology technician, physical therapist) who provided the major portion of your care.
(9 = Most Satisfied to 1 = least satisfied)

Health provider name(s)

The healthcare provider was respectful.
9 8 7 6 5 4 3 2 1 NA
The healthcare provider was concerned about me as an individual.
9 8 7 6 5 4 3 2 1 NA
The healthcare provider explained my treatment clearly.
9 8 7 6 5 4 3 2 1 NA
My questions were answered thoroughly.
9 8 7 6 5 4 3 2 1 NA

OVERALL EXPERIENCE
(9 = Most Satisfied to 1 = least satisfied)

Overall, I liked the food service at Pullman Regional Hospital.
9 8 7 6 5 4 3 2 1 NA
Overall, I am happy with the treatment I received at Pullman Regional Hospital.
9 8 7 6 5 4 3 2 1 NA

GENERAL QUESTIONS

Was this your first visit to Pullman Regional Hospital as a patient?
YES NO

When were you a patient at Pullman Regional Hospital?

Why did you choose PMH for your care? (check all that apply)
Physician recommendation
Location
Previous experience
Hospital reputation
Availability of services
Insurance requirements
Emergency transportation
Advertisements
Friend/relative recommendation
Other

Would you recommend Pullman Regional Hospital to your friends?
YES NO
Why?

Would you use Pullman Regional Hospital for your future health care needs?
YES NO
Please explain.

Are you a:
student?  community member?

Gender Female Male
Age:

Did you find anyone especially helpful?

Do you have any suggestions as to how we could improve our services or better meet the healthcare needs of our region?

How did you arrive at Pullman Regional Hospital?
Auto Ambulance Police Walked

Would you like someone to contact you about your comments?
YES NO
Name:


Address:

Phone:

Email:

Thank you for your participation.