| Question | Not Applicable | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree |
| Staff were professional (respected privacy, listened to concerns, communicated information) | 0 | 0 | 0 | 0 | 3 | 9 |
| I never overheard staff discuss other patients | 0 | 1 | 0 | 0 | 3 | 8 |
| Staff were friendly | 0 | 0 | 0 | 0 | 1 | 11 |
| Treatment started on time without excessive delays | 0 | 0 | 1 | 0 | 4 | 6 |
| I was treated with respect | 0 | 0 | 0 | 0 | 3 | 8 |
| Staff responded in a timely manner (call light, eating, drinking, dressing, bathroom, medications, etc) | 0 | 0 | 0 | 1 | 1 | 10 |
| I feel comfortable asking questions of my care providers | 0 | 0 | 0 | 0 | 3 | 8 |
| I received assistance with my emotional needs | 2 | 0 | 0 | 1 | 2 | 6 |
| The patient received quality care | 0 | 0 | 0 | 0 | 3 | 9 |
| My privacy was respected | 0 | 1 | 0 | 0 | 1 | 9 |
| If needed, I (or your family) chose my followup care provider (physical therapy, homecare,etc) | 5 | 0 | 0 | 0 | 2 | 4 |
| I felt prepared to continue care after discharge | 1 | 0 | 0 | 0 | 2 | 9 |
| I had enough advance notice to pick up the patient at discharge | 0 | 0 | 0 | 0 | 0 | 1 |
| If you waited while the patient had a procedure/service performed, your wait time was as planned | 0 | 0 | 0 | 0 | 0 | 1 |
| I was comfortable during my wait | 0 | 0 | 0 | 0 | 0 | 1 |
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