Returning Patients

Patient Consultation Form

We would like to establish a forum that allows patients who have come in for their consultation and surgery to provide feedback for all of us here on staff. What did we do right? What can we do better to serve our patients? This feedback forum is not a substitute for your medical care. If you have questions or need our assistance please pick up the phone and call our office so that we can attend to them.

You can also fill out a patient review for Dr. Jewell on RealSelf by clicking here.

We value your insights. Please consider participating in the following survey by answering the questions below or write about a particular instance that will help us gain a better understanding of your experience.

Name: *


Phone Number:


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



 

 
 
 

OUR ADDRESS

10 Coburg Road, Suite 300
Eugene, OR 97401

Phone: 541-683-3234
Fax: 541-683-8610
Email: info@markjewellmd.com

FOLLOW US

  • Facebook

© Copyright 2010 Jewell Plastic Surgery Center, all rights reserved. Privacy policy