Referral Provider - Satisfaction 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.

Please rank the following questions as:

A = Excellent D = Fair
B = Very Good E = Poor
C = Good F = Does not Apply


(Click on the appropriate circle)
 A  B  C  D  E  F
1. Efficiency of referral process:
Ease of referring your patient for assessment.
2. Efficiency of admitting procedure:
Ease of admitting process in transferring patient into the hospital.
3. Ease of getting information:
How clearly and completely the staff answer your questions.
4. Quality of services:
How well do you rate the knowledge and clinical services provided by the following disciplines.
Physical Therapy
Occupational Therapy
Speech-Language Therapy
Recreational Therapy
Nursing
Audiology
Medical Social Work
Case Management/ Admissions Nurse
5. Discharge process:
How well is information and coordination of care provided to you upon discharge of your patient from our facility?
6. Additional comments are requested: