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BGH Patient Feedback Form
I received all of the required information in advance prior to my visit.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My appointment time was convenient.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My privacy/confidentiality was respected at all times.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I found the patient area to be comfortable and pleasant.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
The staff was courteous and professional.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My procedure and any education materials provided to me were explained to me in a way that I could understand.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
Responses to my inquiries or requests were completed efficiently.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My room and the hospital in general was clean.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
The quality of food and service delivery (if hospitalized) was high.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
It was easy to navigate around the hospital.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during your visit?
*
0
1
2
3
4
5
6
7
8
9
10
10
Please indicate which area(s) you received service at the hospital:
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Rehabilitation (Garden St)
Complex Continuing Care (Garden St)
Palliative Care (Garden St)
Maternal Child (1North) (Charles St)
Med/Surg (1East/2East) (Charles St)
Mental Health Inpatient (Charles St)
Mental Health Outpatient (Front Ave., Community)
Intensive Care (ICU) (Charles St)
Ambulatory Care (ACU) (Charles St)
Day Surgery (Charles St)
Diagnostic Imaging (Charles St)
Emergency (Charles St)
Laboratory (Charles St)
Mammography (Charles St)
Rehab Therapy (Physio/Occupation/Speech/Recreation)
Spiritual Care
Other
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