At Mercy Hospital & Medical Center, we are committed to keeping Patients 1st. To meet this standard, we need to know what we are doing well and what we can improve. This means we depend on you to help keep us informed. Please take a moment to complete this survey. All of your responses and comments, both positive and negative, are welcome and will remain confidential. Suggestions and comments may also be shared via our Mercy Cares line at 312.567.2003.



Thank you for your feedback and the opportunity to better serve you!

Was your visit:
Inpatient Stay Outpatient Visit Mercy Works Visit

For Outpatient Visits, please tell us the nature of your visit? (ie: physician office visit, lab tests, xray, emergency room, etc.):

For Inpatient Stays, which floor did you visit during your stay?

How were you referred to Mercy Hospital or MercyWorks?
Primary Care Physician Relative or Friend Advertisement Employer Other

How would you rate:
Your treatment by Mercy staff members? Excellent Good Fair Poor

The efficiency of the registration process? Excellent Good Fair Poor

The explanation of the procedure and the opportunity to have your questions answered? Excellent Good Fair Poor

The waiting and exam time? Excellent Good Fair Poor

The cleanliness and neatness of the environment? Excellent Good Fair Poor

Would you recommend Mercy to your family members and friends? Yes No

We welcome additional comments and recommendations:

Name/Number - should you require a returned phone call to discuss the matter. (optional):

Physician (optional):