Submit 0 – worst care possible
Submit 1
Submit 2
Submit 3
Submit 4
Submit 5
Submit 6
Submit 7
Submit 8
Submit 9
Submit 10 – best care possible
Would you recommend this emergency room to your friends and family?
Submit Definitely no
Submit Probably no
Submit Probably yes
Submit Definitely yes

thinking about the 30 days before this visit, how many times did you go to this emergency room to get care for yourself for any reason? Please include the emergency room visit you have been answering questions about in this survey.

Submit 1 time
Submit 2 times
Submit 3 times
Submit 4 or more times
In the last 6 months, how many times have you visited any emergency room to get care for yourself? Please include the emergency room visit you have been answering questions about in this survey.
Submit 1 time
Submit 2 times
Submit 3 times
Submit 4 times
Submit 5 to 9 times
Submit 10 or more times
Not counting the emergency room, is there a doctor’s office, clinic, or other place you usually go if you need a check-up, want advice about a health problem, or get sick or hurt?
Submit Yes
Submit No
Before you left the emergency room, did a doctor or nurse tell you what the new medicines were for?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
Before you left the emergency room, did someone tell you to make an appointment with a doctor to follow-up about your problem?
Submit Yes
Submit No

LEAVING THE EMERGENCY ROOM
Before you left the emergency room, did you understand what your main health problem was?
Submit Yes
Submit No
Before you left the emergency room, did you understand what symptoms or health problems to look out for when you left the emergency room?
Submit Yes
Submit No
Before you left the emergency room, did a doctor or nurse tell you that you should take any new medicines that you had not taken before?
Submit Yes
Submit No
PEOPLE WHO TOOK CARE OF YOU
Please answer the following questions about the people who took care of you during your emergency room visit.
During this emergency room visit, how often did doctors, nurses, or emergency room staff introduce themselves to you the first time they came to take care of you?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, were you kept informed about who was in charge of your care?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
During this emergency room visit, how often did nurses treat you with courtesy and respect?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, how often did nurses listen carefully to you?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, how often did nurses explain things in a way you could understand?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, did nurses spend enough time with you?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
During this emergency room visit, how often did doctors treat you with courtesy and respect?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, how often did doctors listen carefully to you?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, how often did doctors explain things in a way you could understand?
Submit Never
Submit Sometimes
Submit Usually
Submit Always
During this emergency room visit, did doctors spend enough time with you?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
During this emergency room visit, did doctors and nurses give you as much information as you wanted about the results of these tests?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
An interpreter is someone who helps you talk with others who do not speak your language. During this emergency room visit, did you need an interpreter?
Submit Yes
Submit No
During this emergency room visit, did you get medicine for pain?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
During this emergency room visit, did the doctors and nurses do everything they could to help you with your pain?
Submit Yes, definitely
Submit Yes, somewhat
Submit No
During this emergency room visit, did you have a blood test, x-ray, or any other test?
Submit Yes
Submit No

During this emergency room visit, did you have any pain?
Submit Yes, definitely
Submit Yes, somewhat
Submit No

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