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Inpatient Stay Feedback Form
Which Inpatient Unit(s) were you admitted to? (select as many as you'd like)
*
1 East
2 East
Maternal Child
Intensive Care Unit (ICU/SDU)
Mental Health Unit
Garden St. - 2nd Floor
Garden St. - 5th Floor
Please rate the following questions regarding your experience at BGH:
I felt welcomed and respected as a patient throughout my visit.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My privacy/confidentiality was respected at all times.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My diagnosis was explained to me in a way that I could understand.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
Treatment for my diagnosis was explained to me in a way that I could understand.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My questions were answered promptly and in a way that I could understand.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My family was included as part of my care team, to the extent that I wanted them to be.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I was given clear discharge instructions (e.g. dietary or physical restrictions, new medications, symptoms to watch for, etc.) to be able to manage my condition at home.
*
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
My room, and the Hospital in general, was clean.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My linen was clean, and sufficient quantities were available.
*
Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
The quality of food, and service delivery, was high.
*
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 Inpatient stay?
*
0
1
2
3
4
5
6
7
8
9
10 (Best)
10 (Best)