1. Were telephone calls to the hospital answered promptly and courteously?
Always Mostly Sometimes Never Does not apply

2. Was the non-clinical staff (receptionists, others) friendly, helpful and understanding?
Always Mostly Sometimes Never Does not apply

3. Was the clinical staff friendly, helpful, and compassionate?
Always Mostly Sometimes Never Does not apply

4. Was the doctor friendly, helpful and compassionate?
Always Mostly Sometimes Never Does not apply

5. Was the department you utilized clean, neat, and organized?
Always Mostly Sometimes Never Does not apply

6. Would you recommend Feather River Hospital’s services to your friends?
Always Mostly Sometimes Never Does not apply

7. Do you feel we did a good job in protecting your confidentiality? If no, please comment.
Yes No

8. What did you like best about our services/facility?

9. What did you like least about our services/facility?

10. How can we improve? (Services, facility, people, processes, anything else)

11. What departments did you use?
Anticoagulation Clinic
Bronchoscopy
Cancer Center
Cardiac Rehabilitation Services
Cardiology/EEG
Chaplain Services
Diabetes Educational Clinic
Emergency Services
Family Health Center
Feather River Outpatient Center
Gift Shop
Home Health
Home Infusion
Home Oxygen
Hospice
Laboratory
Nutritional Services
Pharmacy
Pulmonary Function
Rehabilitation services (Physical Therapy/Occupational Therapy/Speech Therapy)
Respiratory Services
Same Day Services
Sleep Study
X-ray Department
Inpatient Services - Unit or Department
Other (please indicate):

12. Is there anyone you want us to recognize for doing a good job?

13. All comments will remain confidential unless you indicate otherwise. If you wish to be contacted, please indicate in the space provided at the bottom of the survey.

Name:
Address:
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Telephone:
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