You must have JavaScript enabled to use this form. Facility * - Select -Campbellton Regional HospitalChaleur Regional HospitalDr. Georges-L.-Dumont University Hospital CentreEdmundston Regional HospitalEnfant-Jésus RHSJ† HospitalGrand Falls General HospitalHôtel-Dieu Saint-Joseph de Saint-QuentinLamèque Hospital and Community Health CentreRestigouche Hospital CentreStella-Maris-de-Kent HospitalTracadie-Sheila Hospital Unit Date Were you: Admitted through the Emergency Department Admitted by a physician (planned admission) Admitted unexpectedly after a procedure or test Other After learning that you needed to be admitted, did you have to wait too long before getting a bed? Yes No During your hospital stay, how often did the staff treat you with courtesy and respect? Never Sometimes Usually Always During your hospital stay, how often did the staff explain things in a way you could understand? Never Sometimes Usually Always During your hospital stay, how often did you get help as soon as you requested, after you pressed the call button? Never Sometimes Usually Always I never pressed the call button Before giving you any new medication, how often did the hospital staff tell you what the medication was for? Never Sometimes Usually Always I didn’t receive any new medication Were you involved as much as you wanted to be in decisions about your care and treatments? Never Sometimes Usually Always Were your family or friends involved as much as you wanted in decisions about your care and treatments? Never Sometimes Usually Always I didn’t want them to be involved I didn’t have any family or friends to be involved During your hospital stay, how often was your pain under control? Never Sometimes Usually Always I didn’t experience any pain The hospital staff took my cultural values and those of my family or caregiver into account. Strongly disagree Disagree Agree Strongly agree Don’t know/Not applicable During your hospital stay, how often were your room and bathroom cleaned? Never Sometimes Usually Always During your hospital stay, how often was the area around your room quiet at night? Never Sometimes Usually Always How would you rate the quality of the food? (how it tasted, serving temperature, variety) Poor Fair Good Very good Excellent During your hospital stay, did the visiting hours for your family/friends meet your needs? Never Sometimes Usually Always My family/friends didn’t visit Did you notice the staff washing or disinfecting their hands before caring for you? Yes, always Yes, sometimes Never I didn’t notice I didn’t see any facilities for washing/disinfecting hands Do you believe that this hospital takes your safety seriously? Yes, definitely Yes, somewhat No Did the staff check your identification band before giving you medications or performing treatments or tests? Yes, always Yes, sometimes No I don't remember During your hospital stay, did you get information in writing about what symptoms or health problems to look for after you left the hospital? Yes No Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your hospital stay? Not at all Partly Quite a bit Completely Not applicable Under the Official Languages Act, you have the right to be served in either English or French. Which of these two languages do you prefer? French English How often did you receive the service you needed in the official language of your choice (English or French) while in the hospital? Never Sometimes Usually Always Overall, how was your experience during your hospital stay? 0 being the worst experience and 10 the best 012345678910 Is there anything else you would like to share about your hospital stay? Optional Name Telephone Thank you for taking the time to complete this survey! Leave this field blank