Outpatient Services Feedback Form

Which Outpatient Service did you attend? *

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) *

I knew where to go when I arrived at the Hospital *

I felt welcomed and respected as a patient throughout my visit. *

My privacy/confidentiality was respected at all times. *

Any diagnosis/treatment/procedure was explained to me in a way that I could understand. *

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. *

My questions were answered promptly and in a way that I could understand. *

I found the patient area to be comfortable and pleasant. *

The Clinic area, and the Hospital in general, was clean. *

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? *