Name: (Optional)


Phone Number: (Optional)


Email: *


1)  Were the registration and admitting procedures completed in a reasonable time?
Yes
No

2)  Did we listen to what you wanted to accomplish?
Yes
No

3)  Were there moments where we failed to deliver the service you were expecting?
Yes
No

4)  Did you feel as though you were part of the team in deciding what the goals of your surgery would be?
Yes
No

5)  Did your pre op visit effectively prepare you for surgery?
Yes
No

6)  Were all your needs attended to in the operating room?
Yes
No

7)  Were your discharge instructions complete and adequate?
Yes
No

8)  Was your post op and recovery reasonably comfortable?
Yes
No

9)  Were you treated with courtesy and respect throughout your entire experience?
Yes
No

10)  Please tell us about your experience, what you liked, and what we can do better.






* Required Fields