Patient Survey

Please take a few minutes to help us make sure we are providing the Mercy Touch! Thank You!

* Indicates required field

What is your hospital of choice? *

Mercy Medical Center St. Lukes Hospital

Why: *

Are you: *

Male Female

What is your Urgent Care of choice? *

MercyCare North MercyCare South MercyCare Marion St. Lukes - Unity Point Urgent Care

Please tell us why this is your Urgent Care of choice. *

What is the main reason you would go to an Urgent Care rather than seeing Dr. Beer? *

Dr. Beer's office was closed when I needed to be seen. I was not able to get into Dr. Beer's office, was told that there were no appointments available. The urgent care was more convenient (closer to me). Other (see below) I do not go to Urgent Cares.

Other Reason: *

If you were going to have a surgical procedure, where would you prefer to have it done? *

Mercy Medical Center St. Lukes Hospital Surgery Center of Cedar Rapids

Why would you prefer to have your procedure there? *

Which of the following would most likely influence your decision on where to have your surgical procedures? *

Dr. Beer's Preference Your personal preference The surgeon's preference

Please select any of the following that are important to you and your healthcare: *

I prefer that my hospital, urgent care center, and family doctor all have access to my chart so that they are fully informed regarding my health. I prefer to have online access to my medical records. I prefer to have online access to my family doctor for questions. I prefer to have online access to schedule appointments with my family doctor. I prefer that my family doctor has full access to my hospital and urgent care records to provide the most appropriate health care. I prefer to have separate health records, with my family doctor records not connected to urgent care records or hospital records. I prefer that any specialist I may see has access to my health record to make appropriate recommendations regarding my health.

In the past, have you had any experiences at Mercy Medical Center that would cause you to prefer other hospitals? If so, could you explain? *

What does the Mercy Touch mean to you? *

Your Name (Optional) *

Your Email (Optional) *