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Adult Intensive Care Patient Survey

Dear ICU patient and families:

In order to meet your healthcare needs, provide quality care and continue to improve customer service, please take a few moments to complete the following survey.

* Indicates required information
How well did our staff:
VERY WELL
NOT WELL
take care of your specific/ personal needs: * 
work together to care for you? * 
introduce themselves when entering the room * 
How well were you and your family kept informed about your treatments and tests:
VERY WELL
NOT WELL
by our Nurses * 
by our Physicians * 
Was staff readily available?
ALWAYS
SOMETIMES
RARELY
Nurses * 
Physicians * 
Respiratory Therapists * 
Physical Therapists * 
Speech Therapists * 
How would you rate:
EXCELLENT
POOR
cleanliness of the room * 
Housekeeping staff * 
Respiratory Therapists * 
Physical Therapists * 
Speech Therapists * 
overall ICU experience * 
Were your pain needs addressed sufficiently? * 
ALWAYS
SOMETIMES
RARELY
What did you find the most positive about your experience? 
What part of your stay can we improve upon? 
Was there any one that was extremely helpful to you? 
Date * 
 Calendar (mm/dd/yyyy)
Which unit were you assigned to: * 
I am a * 
Email Address