Patient Care Feedback Survey Form: Your Voice Matters!

We value your experience at Nueva Ecija Medical Center and are committed to continuous improvement. Please take a few moments to share your feedback.

Following are the questions about your most recent Inpatient visit. Please select the option that best describes your experience. If a question does not apply to you, please skip to the next question. If you cannot complete the survey, a family member may do so for you. Your answer will help us to improve our services.

Feedback Form

Your insights are valuable to us. Please share your thoughts!
Takes 3 minutes
1
Registration
2
Facility and Personal Issues
3
Your Care
4
Overall Assessment
5
Choosing NEMC
6
Consent
Helpfulness of the person at the registration desk
Ease of the registration process
Waiting time in registration
Comfort of the waiting area
Efficiency of the payment process
1: Poor
5: Excellent
Registration
2
Facility and Personal Issue
3
Your Care
4
Overall Assessment
5
Choosing NEMC
6
Consent
Overall comfort/quality of facility
Our sensitivity to your needs
Overall security in the hospital
1: Poor
5: Excellent
Registration
Facility and Personal Issue
3
Your Care
4
Overall Assessment
5
Choosing NEMC
6
Consent
Staff's explanation of the test or treatment
Staff provided opportunity to ask questions
Your trust in the skill of the staff who provided your test or treatment
Staff's concern for your comfort
Staff treated you with respect and dignity
Staff's concern to verify your name before testing or treatment was performed
Response to concerns/complaints made during your visit
1: Poor
5: Excellent
Registration
Facility and Personal Issue
Your Care
4
Overall Assessment
5
Choosing NEMC
6
Consent
How well staff worked together to provide care
Likelihood of your recommending our facility to others
Registration
Facility and Personal Issue
Your Care
Overall Assessment
5
Choosing NEMC
6
Consent
Reputation for doctors
Reputation for equipment
Through Physician's advice
Through HMO/Insurance
Advertisement and publicity
Company arrangements/corporate accounts
Proximity to hospital
Through previous experience
Hospital staff recommendation
If future hospitalization is required, would you still choose NEMC?
What was the best thing about your experience?
How could we improve the quality of care?
Did any staff member provide excellent care or service? (Who and why?)
Registration
Facility and Personal Issue
Your Care
Overall Assessment
Choosing NEMC
6
Consent
Please type in the following information for reference
Date of Visit
Patient's first visit to our facility
Patient's gender
Patient's age
Who is filling out this form?
Type of Visit
If Admission, what is the room number?
How many minutes did you wait after your scheduled appointment time before you were called to the consultation, test or treatment area?
If you had a test or a treatment, how many minutes did you wait in the test or treatment area before your test or treatment began?
Do you consent to have your name linked to your survey responses and being contacted by a representative if required by the facility?
Your Name
Contact details
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.