Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit . We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template. CourseShare helps people generate, find, and share knowledge related to teaching and learning on the Web. Through CourseShare.com, higher education institutions, corporations, instructors, and students can find support for the global sharing of course information and Internet evaluation, access to 21st century teaching and learning techniques, and Web tools for assessing how well they are performing in this online marketplace.
Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit. We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template.

Emergency Room Visit Web Survey:
This is an example of a Web survey taken from SurveyShares library of web survey templates. This particular web survey is concerned with emergency room visit issues. These questions are intended for patients to answer. It is a patient satisfaction web survey of ER services including waiting time, cleanliness of facilities, and treatment by the staff. If you want to customize this web survey and put in on the Internet, just sign up for the SurveyShare Web survey tool. You can get started free of charge and create a free web survey of your own. Of course, if you decide to to use our web survey software, you can still use these online exmaple questions. We wish you luck with your survey project and hope that you can benifit from our online Web survey resources.

  Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit. We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template.   Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit. We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template.
   
1) Are you male or female
2) What is your age?
3) Do you have health insurance?
4) Why did you visit the emergency room?
Injury or accident
Illness
Maternity care
Mental health
Other:
5) What services, other than seeing a physician, did you receive? (check all that apply)
X-rays
MRI/CAT Scan
EKG/ECG
EEG
Laboratory work
Other:
6) What procedures, if any, did you have?
Stitches
Wound care
Casting for broken bone
Breathing treatment
Other:
7) How long did you wait in the waiting area to be seen by ER staff?
8) How long did you wait in the examination room to be seen by an ER physician?
Please tell us how satisfied you were with each of the following.
9) How satisfied were you with the ease of registration?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
10) The friendliness of the registration staff?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
11) The cleanliness of the waiting area?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
12) The comfort of the waiting area?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
13) The cleanliness of the exam room?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very Dissatisfied
Please tell us how much you agree or disagree with each of the following statements
14) The nurse was knowledgeable.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
15) My nurse fully explained procedures, tests, and/or treatments.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
16) My nurse fully explained the procedures to follow for my after-care at completion of my visit.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
17) My nurse was friendly and treated me with respect.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
18) The doctor was knowledgeable.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
19) The doctor was friendly and courteous.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
20) I was given complete attention by the doctor.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
21) My questions were answered fully.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
22) Overall, how satisfied are you with the quality of the care you received at this hospital?
Very Dissatisfied
Somewhat Dissatisfied
Undecided
Somewhat Satisfied
Very Satisfied
23) Please tell us what, if anything, we can do to improve the emergency room services of this hospital.
 
  Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit. We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template.   Web Survey questions provided by an Internet tool which lets you to build surveys for the web. Medical Web survey about emergency room visit. We also have lots of other web survey templates in our web survey template collection. You can use SurveyShare to build and deploy a web survey with questions from a customizable web survey template.
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