Home / Patient Experience 360 Patient Experience 360 Step 1 of 18 5% Welcome! Enter your code. Your Name(Required) First Last Select a LocationLocation Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Location Phone Outside - Road SignageRoad Signage - Does it meet our brand standards? Yes No Action Recommended - Road Signage - Does it meet our brand standards?Upload a Photo - Road Signage - Does it meet our brand standards? Drop files here or Select files Max. file size: 512 MB. Road Signage - Condition Satisfactory Not Satisfactory Action Recommended - Road Signage - ConditionUpload a Photo - Road Signage - Condition Drop files here or Select files Max. file size: 512 MB. Outside - Centerstone Sign on BuildingCenterstone sign on building - Condition Satisfactory Not Satisfactory Action Recommended - Centerstone sign on building - ConditionUpload a Photo - Centerstone sign on building - Condition Drop files here or Select files Max. file size: 512 MB. Parking LotParking Lot - Condition Satisfactory Not Satisfactory Action Recommended - Parking Lot - ConditionUpload a Photo - Parking Lot - Condition Drop files here or Select files Max. file size: 512 MB. Parking Lot - Lighting Satisfactory Not Satisfactory Not Applicable Action Recommended - Parking Lot - LightingUpload a Photo - Parking Lot - Lighting Drop files here or Select files Max. file size: 512 MB. Sidewalks - Condition Satisfactory Not Satisfactory Action Recommended - Sidewalks - ConditionUpload a Photo - Sidewalks - Condition Drop files here or Select files Max. file size: 512 MB. Landscaping - Condition Satisfactory Not Satisfactory Action Recommended - Landscaping - ConditionUpload a Photo - Landscaping - Condition Drop files here or Select files Max. file size: 512 MB. Front doors and windowsHours Sign - Condition Satisfactory Not Satisfactory Action Recommended - Hours Sign - ConditionUpload a Photo - Hours Sign - Condition Drop files here or Select files Max. file size: 512 MB. Other signage - Condition Satisfactory Not Satisfactory Action Recommended - Other signage - ConditionUpload a Photo - Other signage - Condition Drop files here or Select files Max. file size: 512 MB. Other signage - Are all signs/fliers necessary? Yes No Action Recommended - Other signage - Are all signs/fliers necessary?Upload a Photo - Other signage - Are all signs/fliers necessary? Drop files here or Select files Max. file size: 512 MB. Other signage - Do all signs/fliers meet our brand standards? Yes No Action Recommended - Other signage - Do all signs/fliers meet our brand standards?Upload a Photo - Other signage - Do all signs/fliers meet our brand standards? Drop files here or Select files Max. file size: 512 MB. InsideLobby/waiting roomWhat is your first impression of - Sounds Satisfactory Not Satisfactory Action Recommended - What is your first impression of - SoundsWhat is your first impression of - Visual Satisfactory Not Satisfactory Action Recommended - What is your first impression of - VisualUpload a Photo - What is your first impression of - Visual Drop files here or Select files Max. file size: 512 MB. What is your first impression of - Smell Satisfactory Not Satisfactory Action Recommended - What is your first impression of - SmellWhat is your first impression of - Welcome Satisfactory Not Satisfactory Action Recommended - What is your first impression of - Welcome Walls - Condition Satisfactory Not Satisfactory Action Recommended - Walls - ConditionUpload a Photo - Walls - Condition Drop files here or Select files Max. file size: 512 MB. Paint - Condition Satisfactory Not Satisfactory Action Recommended - Paint - ConditionUpload a Photo - Paint - Condition Drop files here or Select files Max. file size: 512 MB. Paint - Does the color match our palette? Yes No Action Recommended - Paint - Does the color match our palette?Action RecommendedUpload a Photo - Paint - Does the color match our palette? Drop files here or Select files Max. file size: 512 MB. Flooring - Condition Satisfactory Not Satisfactory Action Recommended - Flooring - ConditionUpload a Photo - Flooring - Condition Drop files here or Select files Max. file size: 512 MB. Lighting - Condition Satisfactory Not Satisfactory Action Recommended - Lighting - ConditionUpload a Photo - Lighting - Condition Drop files here or Select files Max. file size: 512 MB. FurnitureSeating - Is there enough seating available? Yes No Action Recommended - Seating - Is there enough seating available?Seating - Condition Satisfactory Not Satisfactory Action Recommended - Seating - ConditionUpload a Photo - Seating - Condition Drop files here or Select files Max. file size: 512 MB. Tables - Condition Satisfactory Not Satisfactory Action Recommended - Tables - ConditionUpload a Photo - Tables - Condition Drop files here or Select files Max. file size: 512 MB. Lamps / standing lights - Condition Satisfactory Not Satisfactory Action Recommended - Lamps / standing lights - ConditionUpload a Photo - Lamps / standing lights - Condition Drop files here or Select files Max. file size: 512 MB. TV / DisplayDoes this location have a TV? Yes No What is playing on the TV?TV / Display - Condition Satisfactory Not Satisfactory Action Recommended - TV / Display - ConditionUpload a Photo - TV / Display - Condition Drop files here or Select files Max. file size: 512 MB. Reading MaterialsWhat reading materials are available:Reading Materials - Condition Satisfactory Not Satisfactory Action Recommended - Reading Materials - ConditionUpload a Photo - Reading Materials - Condition Drop files here or Select files Max. file size: 512 MB. Brochure racks - Condition Satisfactory Not Satisfactory Action Recommended - Brochure racks - ConditionUpload a Photo - Brochure racks - Condition Drop files here or Select files Max. file size: 512 MB. Brochure racks - Are they easily accessible? Yes No Action Recommended - Brochure racks - Are they easily accessible?Brochure racks - Are they stocked with up-to-date brochures? Yes No Action Recommended - Brochure racks - Are they stocked with up-to-date brochures?Flier displays - Condition Satisfactory Not Satisfactory Action Recommended - Flier displays - ConditionUpload a Photo - Flier displays - Condition Drop files here or Select files Max. file size: 512 MB. Flier displays - Are they easily accessible? Yes No Action Recommended - Flier displays - Are they easily accessible? ReputationReputation window clings - Condition Satisfactory Not Satisfactory Action Recommended - Reputation window clings - ConditionUpload a Photo - Reputation window clings - Condition Drop files here or Select files Max. file size: 512 MB. Reputation window clings - Are they easily accessible? Yes No Action Recommended - Reputation window clings - Are they easily accessible?Reputation window clings - Do they meet our brand standards? Yes No Action Recommended - Reputation window clings - Do they meet our brand standards?Reputation table tents - Condition Satisfactory Not Satisfactory Action Recommended - Reputation table tents - ConditionUpload a Photo - Reputation table tents - Condition Drop files here or Select files Max. file size: 512 MB. Reputation table tents - Are they easily accessible? Yes No Action Recommended - Reputation table tents - Are they easily accessible?Reputation table tents - Do they meet our brand standards? Yes No Action Recommended - Reputation table tents - Do they meet our brand standards?Vending machine(s) - Condition Satisfactory Not Satisfactory Action Recommended - Vending machine(s) - ConditionUpload a Photo - Vending machine(s) - Condition Drop files here or Select files Max. file size: 512 MB. Foundation display / donor recognition - Condition Satisfactory Not Satisfactory Action Recommended - Foundation display / donor recognition - ConditionUpload a Photo - Foundation display / donor recognition - Condition Drop files here or Select files Max. file size: 512 MB. Check-in/front desk areaWindow(s) - Condition Satisfactory Not Satisfactory Action Recommended - Window(s) - ConditionUpload a Photo - Window(s) - Condition Drop files here or Select files Max. file size: 512 MB. Fliers/signs on window - Condition Satisfactory Not Satisfactory Action Recommended - Fliers/signs on window - ConditionUpload a Photo - Fliers/signs on window - Condition Drop files here or Select files Max. file size: 512 MB. Fliers/signs on window - Are all signs/fliers necessary? Yes No Action Recommended - Fliers/signs on window - Are all signs/fliers necessary?Fliers/signs on window - Do all signs/fliers meet our brand standards? Yes No Action Recommended - Fliers/signs on window - Do all signs/fliers meet our brand standards? Front DeskFront desk - Condition Satisfactory Not Satisfactory Action Recommended - Front desk - ConditionUpload a Photo - Front desk - Condition Drop files here or Select files Max. file size: 512 MB. Fliers/signs on desk/countertop - Condition Satisfactory Not Satisfactory Action Recommended - Fliers/signs on desk/countertop - ConditionUpload a Photo - Fliers/signs on desk/countertop - Condition Drop files here or Select files Max. file size: 512 MB. Front Desk - Are all signs/fliers necessary Yes No Action Recommended - Front Desk - Are all signs/fliers necessaryFront Desk - Do all signs/fliers meet our brand standards? Yes No Action Recommended - Front Desk - Do all signs/fliers meet our brand standards?Upload a Photo - Front Desk - Do all signs/fliers meet our brand standards? Drop files here or Select files Max. file size: 512 MB. Front Desk - DocumentsWelcome packet - Condition Satisfactory Not Satisfactory Action Recommended - Welcome packet - ConditionUpload a Photo - Welcome packet - Condition Drop files here or Select files Max. file size: 512 MB. Welcome packet - Are all materials inside necessary? Yes No Action Recommended - Welcome packet - Are all materials inside necessary?Welcome packet - Do all materials in the packet meet our brand standards? Yes No Action Recommended - Welcome packet - Do all materials in the packet meet our brand standards?Discharge packet - Condition Satisfactory Not Satisfactory Action Recommended - Discharge packet - ConditionUpload a Photo - Discharge packet - Condition Drop files here or Select files Max. file size: 512 MB. Discharge packet - Are all materials inside necessary? Yes No Action Recommended - Discharge packet - Are all materials inside necessary?Discharge packet - Do all materials in the packet meet our brand standards? Yes No Action Recommended - Discharge packet - Do all materials in the packet meet our brand standards?Appointment cards - Condition Satisfactory Not Satisfactory Action Recommended - Appointment cards - ConditionUpload a Photo - Appointment cards - Condition Drop files here or Select files Max. file size: 512 MB. Appointment cards - Are all materials inside necessary? Yes No Action Recommended - Appointment cards - Are all materials inside necessary?Appointment cards - Do all materials in the packet meet our brand standards? Yes No Action Recommended - Appointment cards - Do all materials in the packet meet our brand standards?Reputation cards - Condition Satisfactory Not Satisfactory Action Recommended - Reputation cards - ConditionUpload a Photo - Reputation cards - Condition Drop files here or Select files Max. file size: 512 MB. Reputation cards - Are all materials inside necessary? Yes No Action Recommended - Reputation cards - Are all materials inside necessary?Reputation cards - Do all materials in the packet meet our brand standards? Yes No Action Recommended - Reputation cards - Do all materials in the packet meet our brand standards?Describe takeaway document(s):Other documents/takeaways - Condition Satisfactory Not Satisfactory Action Recommended - Other documents/takeaways - ConditionUpload a Photo - Other documents/takeaways - Condition Drop files here or Select files Max. file size: 512 MB. Other documents/takeaways - Are all materials inside necessary? Yes No Action Recommended - Other documents/takeaways - Are all materials inside necessary?Other documents/takeaways - Do all materials in the packet meet our brand standards? Yes No Action Recommended - Other documents/takeaways - Do all materials in the packet meet our brand standards? Staff - AttireDoes the front desk staff’s dress, personal appearance and grooming meet Centerstone’s policy? Yes No Not Applicable Action Recommended - Does the front desk staff’s dress, personal appearance and grooming meet Centerstone’s policy?Does the attire reflect Centerstone’s brand? Yes No Not Applicable Action Recommended - Does the attire reflect Centerstone’s brand?Staff - BadgesBadges - Are badges visible? Yes No Not Applicable Action Recommended - Badges - Are badges visible?Badges - Are badges readable? Yes No Not Applicable Action Recommended - Badges - Are badges readable?Badges - Do badges meet our brand standards? Yes No Not Applicable Action Recommended - Badges - Do badges meet our brand standards? Inside - Lobby / Waiting RoomWater fountains - Condition Satisfactory Not Satisfactory Action Recommended - Water fountains - ConditionUpload a Photo - Water fountains - Condition Drop files here or Select files Max. file size: 512 MB. Lobby RestroomsMen/Women signage - Condition Satisfactory Not Satisfactory Action Recommended - Men/Women signage - ConditionUpload a Photo - Men/Women signage - Condition Drop files here or Select files Max. file size: 512 MB. Restroom inspected Men's Women's Family Restroom - Walls Satisfactory Not Satisfactory Action Recommended - Restroom - WallsUpload a Photo - Restroom - Walls Drop files here or Select files Max. file size: 512 MB. Restroom - Paint Satisfactory Not Satisfactory Action Recommended - Restroom - PaintUpload a Photo - Restroom - Paint Drop files here or Select files Max. file size: 512 MB. Restroom - Does the color match our palette? Yes No Action Recommended - Restroom - Does the color match our palette?Restroom - Flooring Satisfactory Not Satisfactory Action Recommended - Restroom - FlooringUpload - Restroom - Flooring Drop files here or Select files Max. file size: 512 MB. Restroom - Light fixtures Satisfactory Not Satisfactory Action Recommended - Restroom - Light fixturesUpload a Photo - Restroom - Light fixtures Drop files here or Select files Max. file size: 512 MB. Restroom - Sinks Satisfactory Not Satisfactory Action Recommended - Restroom - SinksUpload a Photo - Restroom - Sinks Drop files here or Select files Max. file size: 512 MB. Restroom - Soap Satisfactory Not Satisfactory Action Recommended - Restroom - SoapRestroom - Towels / Drier Satisfactory Not Satisfactory Action Recommended - Restroom - Towels / DrierRestroom - Trash receptacle near sink Satisfactory Not Satisfactory Action Recommended - Restroom - Trash receptacle near sinkRestroom - Trash receptacle in stall(s) Satisfactory Not Satisfactory Action Recommended - Restroom - Trash receptacle in stall(s)Restroom - Smell Satisfactory Not Satisfactory Action Recommended - Restroom - SmellRestroom - Signage in restrooms Satisfactory Not Satisfactory Action Recommended - Restroom - Signage in restrooms ElevatorElevator - Condition Satisfactory Not Satisfactory Action Recommended - Elevator - ConditionUpload a Photo - Elevator - Condition Drop files here or Select files Max. file size: 512 MB. Elevator - Response time Satisfactory Not Satisfactory Action Recommended - Elevator - Response timeElevator - Travel time between floors Satisfactory Not Satisfactory Action Recommended - Elevator - Travel time between floorsElevator - Leveling Satisfactory Not Satisfactory Action Recommended - Elevator - LevelingElevator - Door Operation Satisfactory Not Satisfactory Action Recommended - Elevator - Door OperationElevator - Starting and stopping Satisfactory Not Satisfactory Action Recommended - Elevator - Starting and stoppingElevator - Call Lights Satisfactory Not Satisfactory Action Recommended - Elevator - Call LightsUpload a Photo - Elevator - Call Lights Drop files here or Select files Max. file size: 512 MB. Elevator - Posters/signs/fliers - Do they meet our brand standards? Yes No Action Recommended - Elevator - Posters/signs/fliers - Do they meet our brand standards?Elevator - Posters/signs/fliers - Condition Satisfactory Not Satisfactory Action Recommended - Elevator - Posters/signs/fliers - ConditionElevator - Lighting Satisfactory Not Satisfactory Action Recommended - Elevator - LightingUpload a Photo - Elevator - Lighting Drop files here or Select files Max. file size: 512 MB. StairsStairs - Condition Satisfactory Not Satisfactory Action Recommended - Stairs - ConditionUpload a Photo - Stairs - Condition Drop files here or Select files Max. file size: 512 MB. Stairs - Lighting Satisfactory Not Satisfactory Action Recommended - Stairs - LightingUpload a Photo - Stairs - Lighting Drop files here or Select files Max. file size: 512 MB. Stairs - Posters/signs/fliers - Do they meet our brand standards? Yes No Action Recommended - Stairs - Posters/signs/fliers - Do they meet our brand standards?Stairs - Posters/signs/fliers - Condition Satisfactory Not Satisfactory Action Recommended - Stairs - Posters/signs/fliers - ConditionUpload a Photo - Stairs - Posters/signs/fliers - Condition Drop files here or Select files Max. file size: 512 MB. OtherUpload a Photo - Other Drop files here or Select files Max. file size: 512 MB. Shout OutUpload a Photo - Shout Out Drop files here or Select files Max. file size: 512 MB. EmailThis field is for validation purposes and should be left unchanged.
