PATIENT SATISFACTION SURVEY

The philosophy of Sterling Healthcare & Rehab Center emphasizes commitment to excellence. The pursuit of quality is a continuous evaluation of performance. We would appreciate your comments to assist us in providing high quality healthcare services.

E = Excellent
G = Good
F = Fair
P = Poor		 Y = Yes
N = No
Nursing Services
E
G
F
P
  
Professionalism of Nursing Staff  
Adequacy of explanation of your
Medical care and treatment
  
Courtesy of Nursing Staff  
Promptness of response to
requests or concerns
  
Comments
      
Interdisciplinary Team Conf.
Y
N
  
Were you notified of Meetings?      
Did you attend meetings?
     
Were the meetings helpful?      
Comments
      
Housekeeping/Laundry
E
G
F
P
Comfort  
Cleanliness
  
Courtesy of Housekeeping Staff  
Television Service  
Cleanliness and condition of laundry
 
Comments
      
Food Service
E
G
F
P
Quality of Food  
Food temperatures
  
Courtesy of Dietary Staff  
Responsiveness of Dietician  
Comments
      
Rehabilitation Services
E
G
F
P
Physical Therapist
  
Occupational Therapy  
Speech Therapy  
Restorative Nurse Aide  
Resident’s collaboration and
involvement in goal setting.
  
Y
N
Were your goals met?      
Comments
      
Activities/Recreation
E
G
F
P
Professionalism of Staff  
Quality of programming  
Variety of programming
 
Comments
      
Social Services
E
G
F
P
Professionalism of Staff  
Knowledge of Staff  
Promptness of response to
requests or concerns
 
Comments
      
Admissions
E
G
F
P
Professionalism of Staff  
Knowledge of Staff  
Promptness of response to
requests or concerns
 
Comments
      
Business Reception
E
G
F
P
Were you treated with courtesy?  
Were your questions answered?  
Were you billed timely?
  
Comments
      
Physician Services
E
G
F
P
Physician response to your needs  
Explanation of your medical care
and treatment
 
Consultant physicians
  
Comments
      
What did you like about your or your family member’s stay at Sterling Healthcare & Rehab Center?
      
Would you suggest any changes to improve delivery of service?
       
Is there a specific staff member that you would like to commend for his/her special effort in making you or your family member’s stay a positive one?

Name

Department
Why did you choose Sterling Healthcare? Choose as many as apply.

Reputation
Physician Recommendation
Specialized Service
Relative/Friend Recommendation
Location
Hospital Referral
Other (write below):
Thank you for your time. If you would like a personal phone call to discuss this questionnaire, please provide us with your name and phone number.

Name

Phone Number



 
 

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