Patient Experience Survey

Please complete this survey to help us improve our care and services in order to achieve our mission:


Committed to compassionate, forward-thinking, quality-driven, and safe health care that honors the community


Contact GMHA Guest Relations

Phone 671-647-2503/671-648-7981 or Email guestrelations@gmha.org

 

Would you like to participate in GMHA's raffle drawing?


(Both your name and contact number required. Must be 18 years old and above to participate)


 
 

Contact Info

 
 
 
 
mm/dd/yyyy
 

 

Demographic Info

 
 
 
 
 
 
 

 

Please indicate how often each was provided

 

General Impressions of GMH

 
 
 

 
 

Interaction with Hospital Staff

 

Registration Department

 
 
 
 
 

Nursing

 
 
 
 
 
 
 

Doctor's Services

 
 
 
 
 
 

Billing Department

 
 
 
 
 

 

In-House Care

Hospitality Services provided to you during your stay

 

 

Cleanliness

House Keeping Services

 
 
 
 
 

Hospital Environment

Accommodations

 
 
 
 
 

Food

Quality of the Food

 
 
 
 
 

Pain Control

 
 
 

The hospital staff did everything they could to help with the pain.

 

Assisted Restroom Use

 

How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

 

 

Discharge

 

During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?

 

 

Other Hospital Services

Outpatient and Other Services (click yes to see these services)

 
 

 

Privacy/ Language

 

Staff kept my medical condition and treatment private.

 

My health care needs were discussed in the language of my choice.

 

 

 

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