Patient Satisfaction Survey

If you or a loved one recently received services at Meriter Hospital, we would appreciate your feedback on the care you experienced. Your feedback will help us learn what you liked and what we can do to better meet our community's needs.

Please answer the following questions and hit the "submit" button when you have completed the survey. If you would like to receive a reply, please include your contact information.

Who received services at Meriter? * Me Loved One

Which area of Meriter did you/your loved one receive services from? (If you were cared for in the Birthing Center, please note which floor you were on.) * Please share your comments or impressions.

If you would like a phone call or e-mail to discuss your care more thoroughly, please include your name and contact information below:

Name Phone Email

Do you want a Meriter representative to follow-up with you? * Yes No

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ER - Madison

Patient Satisfaction Survey

If you would like a phone call or e-mail to discuss your care more thoroughly, please include your name and contact information below:

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