Transfer Center Feedback Survey

Date of experience *

Year

Month

Day

Was Regional West your first choice for this patient entry/transfer event?

Yes

No

How satisfied were you with the timeliness with which your transfer request into Regional West was handled?

How satisfied were you with the clinical interaction that you had with Regional West staff during the transfer process?

Were your expectations of the Transfer Center process met?

Absolutely

Yes

Somewhat

No

Are there other concerns or comments that you have regarding Regional West's patient entry/transfer process?

Name

Facility

Email Address

Regional West