Patient Feedback

You are a *

Rate your experience

1 star = Poor, 5 stars = Excellent. Skip a question if it doesn’t apply to you.

1. 1

   Was the hospital clean and comfortable?

   1 – Poor2 – Okay3 – Good4 – Very good5 – Excellent
2. 2

   Are you satisfied with your doctor?

   1 – Poor2 – Okay3 – Good4 – Very good5 – Excellent
3. 3

   Was our staff friendly and helpful?

   1 – Poor2 – Okay3 – Good4 – Very good5 – Excellent
4. 4

   How was your overall experience in terms of finances?

   1 – Poor2 – Okay3 – Good4 – Very good5 – Excellent
5. 5

   Overall, are you satisfied with The Modern Hospital? *

   1 – Poor2 – Okay3 – Good4 – Very good5 – Excellent

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