Orthopedics Patient Feedback | Waterbury Hospital

First Name

Last Name

Phone Number

Email Address

What type of orthopedic service did you receive at Waterbury Hospital? Joint Replacement Arthroscopic Surgery/Sports Medicine Spine Surgery Fracture Treatment Other

How did you learn about Waterbury Hospital’s Orthopedic Program? Physician Referral Online Search Family/Friend Recommendation Previous Patient Experience Other

What date was your surgery?

How would you rate the clarity of the information provided to you before your surgery? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent). 1 5

How well were your questions and concerns addressed? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How easy was the scheduling process? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How well were you kept informed about your care and recovery plan? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 4

How comfortable were you during your hospital stay? • Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How would you rate the professionalism and friendliness of the hospital staff? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How would you rate the cleanliness of the hospital and your room? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How clearly did your orthopedic provider and care team explain post-surgical care and recover instructions? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent) 1 5

How satisfied were you with your follow-up care? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent). 1 5

How prepared do/did you feel for your recovery at home? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent). 1 5

How likely are you to recommend Waterbury Hospital’s Orthopedic program to others? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent). 1 5

How would you rate your overall experience with Waterbury Hospital’s Orthopedic Program? Please rate each question on a scale of 1-5: 1 (Poor), 2 (Fair), 3 (Good), 4 (Very Good), and 5 (Excellent). 1 5

What could we do to improve your experience?

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Orthopedic Patient Feedback