Emergency Department Patient and Family Experience Survey

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* 1. Who is completing this survey?

Patient

Family Member/Caregiver

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* 2. Your experience was at which Huron Health System Facility?

Alexandra Marine and General Hospital (AMGH - Goderich)

South Huron Hospital (SHH - Exeter)

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* 3. If you had a long wait, were you told why?

Yes

No, but I would have liked a reason

No, but I did not mind

Don't know/Can't remember

I did not have a long wait

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* 4. Did the health professionals treating and examining you introduce themselves?

Yes, all of the staff introduced themselves

Some of the staff introduced themselves

Very few or none of the staff introduced themselves

Don't know/Can't remember

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* 5. How often did care providers treat you with courtesy and respect?

Never

Sometimes

Usually

Always

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* 6. How often did care providers explain things in a way you could understand?

Never

Sometimes

Usually

Always

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* 7. Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?

Never

Sometimes

Usually

Always

Don't know/Not sure

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* 8. Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit?

Never

Sometimes

Usually

Always

Not applicable

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* 9. Did the care providers do everything they could do to ease your discomfort or symptoms?

Yes, somewhat

Yes, mostly

Yes

Not applicable

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* 10. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

Not at all

Partly

Quite a bit

Completely

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* 11. Overall...(Please pick a number)

0 I had a very poor experience

10 I had a very good experience

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* 12. What else would you like to say about this emergency department experience? (Please do not include any names, contact information, or identifying information)

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* 13. Is there a staff member or group that you would like to recognize for providing exceptional care or service?

If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.