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Outpatient Services Feedback Form
Which Outpatient Service did you attend?
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Ambulatory Care Unit (ACU)
Cardiac Rehab Unit
Stroke Prevention Clinic
Orthopedic Clinic
Pediatric Programs (Strowger Blvd)
Assault Response and Care Clinic (Strowger Blvd)
Mental Health Outpatient Services (Front Avenue)
Outpatient Physiotherapy Clinic (Garden St.)
Other
Please rate the following questions regarding your experience at BGH:
Prior to my visit, I received all of the information I needed (e.g. how to prepare for my appointment)
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I knew where to go when I arrived at the Hospital
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I felt welcomed and respected as a patient throughout my visit.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My privacy/confidentiality was respected at all times.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
Any diagnosis/treatment/procedure was explained to me in a way that I could understand.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I was given clear instructions (e.g. dietary or physical restrictions, new medications, symptoms to watch for, etc.) to be able to manage my condition at home.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
My questions were answered promptly and in a way that I could understand.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
I found the patient area to be comfortable and pleasant.
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Not Applicable
Strongly Disagree
Disagree
Agree
Strongly Agree
The Clinic area, and the Hospital in general, was clean.
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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?
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0
1
2
3
4
5
6
7
8
9
10 (Best)
10 (Best)