Your Experience

1. How would you rate the overall quality of care you received?

1. Excellent 2. Good 3. Fair 4. Poor

2. How would you rate the communication skills of your healthcare team?

1. Excellent 2. Good 3. Fair 4. Poor

3. Were your pain and discomfort well-managed?

1. Yes 2. No

4. How would you rate the cleanliness and comfort of your room?

1. Excellent 2. Good 3. Fair 4. Poor

Staff

1. Were the nurses attentive and responsive to your needs?

1. Yes 2. No

2. Were the doctors knowledgeable and communicative?

1. Yes 2. No

3. Were the support staff (e.g., food service, housekeeping) friendly and helpful?

1. Yes 2. No

Discharge and Follow-up

1. Were you provided with clear instructions for self-care and follow-up appointments?

1. Yes 2. No

2. Were you satisfied with the coordination of your care after discharge?

1. Yes 2. No

Additional Comments

Is there anything we did well or could improve on? Do you have any suggestions for us?