Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Bacon County Hospital

Patient Satisfaction Survey

Thank you for taking the time to complete this questionnaire. Your information will be very helpful as we seek to provide only the highest quality care to the people in this community.
Please answer all questions with a "yes" or "no" answer. Any comments can be written in the space provided below.
* Patient Name
* Date of Service
Format: mm/dd/year
* Date Survey Completed
Format: mm/dd/year
* Question #1: Was the parking adequate? yes
no
* Question #2: Were signs adequate and effective? yes
no
* Question #3: Was the facility neat and clean? yes
no
* Question #4: Did you feel at ease during and after the registration yes
no
* Question #5: Were you satisfied with the length of time to start treatment? yes
no
* Question #6: Were the personnel courteous and respectful? yes
no
* Question #7: Were the doctors courteous and respectful? yes
no
* Question #8: Were your room and bathroom kept clean? yes
no
* Question #9: Were you satisfied with your meals? (within the limits of your diet) yes
no
* Question #10: During your hospital stay, did the doctors, nurses or other hospital staff explain and involve you in decisions about your treatment as much as you wanted? yes
no
* Question #11: During your hospital stay, did you experience pain? (If not, skip to question #13.) yes
no
  Question #12: Were you satisfied with how well your pain was controlled? yes
no
* Question #13: Did you understand your discharge instructions? yes
no
* Question #14: Did you feel like your privacy was protected? yes
no
* Question #15: Did you feel that your safety was assured at all times? yes
no
* Question #16: Would you recommend this hospital to your friends and family? yes
no
* Question #17: Is there at least one person who stood out in meeting your needs while in the hospital? (If so, please write the employees name in the coment box.) yes
no
  Comments