Silver Internal | QuestionPro

How satisfied are you with the following:

Overall cleanliness of the hospital

Efficiency of nursing care

Friendliness and courtesy of the staff

Convenience of location for you

Cost to you

What kind of medical insurance coverage do you have?

How many times have you and any member of your family been to your doctor in the last year?

Which source of care would you prefer if you had a personal injury that could be handled equally well by each of these sources of health care:

I would prefer to go to a walk-in clinic

I would prefer to go to my personal physician

I would prefer to go to the hospital emergency room

Other

If you or a member of your family have received medical care at another hospital while living in the [HOSPITAL] area, why did you choose the other hospital?

A specialist was available

Special hospital care was required that was not available in the local area

My physician practices there

More familiar with that hospital

Wanted a second opinion from another physician

Religious preference

Cost was too high in the local area

Other

When making health care decisions for your family, who is the primary decision maker?

Male (or husband)

Female (or wife)

Jointly (both husband and wife)

What have you heard about the care patients receive at [Hospital]?

Age of person completing this questionnaire:

Marital status of person completing this questionnaire:

Married

Widow(er)

Divorced or separated

Have never been married