Patient Survey

 Patient Satisfaction Survey

Your opinion makes all the difference to us. We care what you think. We want your experience to be the best it can be. Please take a moment and let us know what you liked (or didn’t like) about our services. Any comments would be greatly appreciated. Thank you for your assistance.

Date of Surgery (dd/mm/yyyy)

Over the course of your treatment, how satisfied were you with the following items:

The Receptionist/Secretarial Staff were polite and helpful Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

I received adequate pre-operative instructions regarding my procedure. Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

My pain was well controlled. Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

The surgery center staff was courteous and attentive. Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

I received adequate and easy to understand discharge instructions. Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

Overall satisfaction with this facility? Very Satisfied Somewhat Satisfied Neutral Dissatisfied N/A

How likely would you be to recommend the facility? Very Likely Somewhat Likely Neutral Not Likely N/A

Comments

Thank you for your time and consideration! Your answers will encourage us to improve our services. Our goal is to completely satisfy our patients and their families.

Form – PATIENT SATISFACTION SURVEY.