Outpatient Satisfaction Survey

Thank you for entrusting Pocono Health System with your healthcare. Your feedback is always appreciated and we thank you in advance for completing our outpatient satisfaction survey. 
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Name
  

I. Please check the Pocono Health System service utilized

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Check the service below. Note that some services are provided at multiple locations.




































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How helpful was the information desk? (1 = LOWEST, 5 = HIGHEST)
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Ease of finding your way around? (1 = LOWEST, 5 = HIGHEST)
(Optional) Name
(Optional) Date of Service:
(Optional) Phone Number:

III. Please rate the service you received (1 = Lowest, 5 = Highest)

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Responsiveness of Staff (1 = LOWEST, 5 = HIGHEST)
Comments
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Communication of Staff/Care Provider (1 = LOWEST, 5 = HIGHEST)
Comments:
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Courtesy/Friendliness of Staff/Care Provider (1 = LOWEST, 5 = HIGHEST)
Comments:
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Comfort and Privacy of Environment (1 = LOWEST, 5 = HIGHEST)
Comments:
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Overall Rating (1 = LOWEST, 5 = HIGHEST)
Comments:
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