Professional Documents
Culture Documents
18 24
25 34
35 59
60 or more
Number of days your loved one is/was in the critical care unit:
03
47
8 10
I am the patients:
Husband
Wife
Significant Other
Friend
Father
Mother
Brother
Sister
Son
Daughter
Uncle
Aunt
more than 10
Other __________
(please add)
Satisfied
Not
Certain
Not
Satisfied
Very
Dissatisfied
Very
Satisfied
Satisfied
Not
Certain
Not
Satisfied
Very
Dissatisfied
What else would you like us to know so we can take better care of our patients and their families?
Please feel free to name any individuals you feel are worthy of special recognition: