Satisfaction Survey

If you're experiencing a medical emergency, call 911 immediately or go to the nearest emergency room.
Thank you for completing our survey. Please check the most appropriate response to each of the questions below. It's not necessary to answer every question.
Patient Name (optional):
If you would like someone to contact you, please include your name, phone number and/or email		 First: Middle Initial: Last:
Date of procedure: (MM/DD/YYYY) If you don't know the exact date, please estimate.
Overall impression of the surgical experience:                    
Would you recommend the surgery center to family & friends?        
How did you hear about the surgery center?                    
Pre-Admission visit and/or phone call was clear and helpful:                    
Directions to the surgery center were accurate and easy to follow:                    
Billing and insurance information was clear:                    
The reception staff greeted me promptly, in a professional and courteous manner:                    
The nursing staff was warm and friendly:                    
I received personalized care with compassion, respect and concern for my privacy and my physical comfort:                    
The surgeon demonstrated courtesy and concern:                    
The anesthesiologist/nurse anesthetist demonstrated courtesy and concern:                    
Prior to my admission date, I was made aware that I needed a responsible party to stay with me for 24 hours:                    
At the time of discharge, I was well informed about what to do in the next 24 hours:                    
The written information provided was easy to understand:                    
The telephone follow-up after the procedure was helpful and informative:                    
The care I received was timely and I did not experience any lengthy delays:                    
Please feel free to offer any comments or suggestions in areas where we could improve or areas where we excelled: