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√ Patient Satisfaction Survey of Sleep Health Center Patients

Please help us by taking time to rate our service at Sleep Health Center ("SHC"). We hope that your experience was a pleasant one.

If you feel that our service needs improving in any of the areas listed below, please use the appropriate "Comments" section to explain in detail.

The only optional questions are your name, the date of your sleep session, and the three different comments questions. All other questions must be answered for the server to submit your survey to us. All surveys will remain confidential in accordance with our Privacy Policy and Site Disclaimer. Thank you for your assistance.

Please Note:

DO NOT use this online form for any comments or questions about patient care.
DO NOT describe your medical condition or the medical condition of someone about whom you are writing.
ANY SUBJECT related to patient care must only be discussed in-person or on the phone with our staff and doctors.

Your Name:

Last Name First Name Middle Initial

Date of your Sleep Session at SHC:

Month-MM Day-DD Year-YYYY

REFERRAL
(0) Would you refer a friend to the Sleep Health Center?

Definitely Would Not Refer

Probably Would Not Refer

Might or Might Not Refer

Probably Would Refer

Definitely Would Refer

Not Applicable

SCHEDULING
(1) Sleep Lab was prompt in contacting me to schedule my appointment.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(2) Sleep Lab was accommodating in terms of flexibility of scheduling.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(3) I was informed of directions.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(4) Directions and pre-study instructions were comprehensive and helpful.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(5) I received a confirmation call within 72 hrs. of my appointment.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(6) SCHEDULING COMMENTS (Optional):

EDUCATION
(7) I received educational material from Sleep Lab.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(8) The educational material was helpful and will be useful in the future.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(9) The sleep technician thoroughly explained the sleep study procedure.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(10) I was given the opportunity to view a videotape prior to my study.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(11) The video was informative and beneficial.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(12) EDUCATION COMMENTS (Optional):

ACCOMMODATIONS
(13) Bedroom accommodations.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(14) Restroom accommodations.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(15) Temperature of room.

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(16) Noise Control (while sleeping).

Poor/Strongly Disagree

Below Avg./Disagree

Good/Neutral

Very Good/Agree

Excellent/Strongly Agree

Not Applicable

(17) ACCOMMODATIONS COMMENTS (Optional):

Please re-check that all required questions have been answered, because otherwise the server will not allow your survey to be submitted. Thanks again for taking the time to complete our survey.

Next, click the Submit button, and your survey will be on its way to us!

Respiratory Specialists and Sleep Health Center

The sole practice in Berks County with five Board Certified Sleep Physicians™

2608 Keiser Blvd. · Wyomissing, PA 19610

(610) 685-LUNG (5864)

The Practice of Respiratory Specialists is Limited to Pulmonary Medicine, Sleep Medicine, and Critical Care Medicine,

with Active Staff Privileges at St. Joseph Medical Center and The Reading Hospital and Medical Center, and

Consulting Staff Privileges at HealthSouth Reading Rehabilitation Hospital

Design & Photos by TheWebJockeys.com

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