Patient Survey

We care about your opinion. We are interested in your impression about our services, facility and staff. Your answers to the following questions and your additional comments will be shared with our staff and will help shape the hospital's polices, procedures and programs. With your cooperation and input, we will be able to continuously improve the quality of our rehabilitation services for the region we serve. Thank you for your time.

 

1.

Date of Discharge?

Month January February March April May June July August September October November December

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

2.	Was this your first stay at SW Rehab?	Yes	No
3.	Were you on a special diet during your stay?	Yes	No
4.	Did you have a roommate during your stay?	Yes	No
5.	Have you ever received rehabilitation prior to this admission?	Yes	No
	If yes, where did you receive prior rehabilitation?	Select one: Hospital Outpatient At Home Other
6.	Your sex?	Male	Female
7.	Your age?	Please enter your age in years
8.	Your name? (Optional)
9.	Your telephone number? (Optional)	Area Code	Phone #
10.	If someone other than the patient is completing this survey, please check here:
11.	Why did you select Southwest Regional Rehabilitation Center? (Check all that apply)	Physician Location Insurance	Friend Family Other
	If Other, please specify:
12.	Did you know about Southwest Rehabilitation Hospital before becoming a patient?	Yes	No

Please continue to page 2 our survey by clicking on the Submit button below.

 

Home | Search | Physicians | Health Links About SRRC | Contact Us | Inpatient Services | Outpatient Services | News Referral, Admit, Discharge | Choosing Rehab Services | Medical Records | Business Office | Human Resources | Medical Social Work | Patient Survey | Provider Survey

Southwest Regional Rehabilitation Center 393 E. Roosevelt Battle Creek, Michigan  49017 269.965.3206