Patient Survey

It was our pleasure to serve you! Think about you or your family member's visit, how would you rate our facility on:

Information and instructions given to you before your proceedure.

Staff explanation about billing and insurance information.

Information given to you about the potential risks/complications of the type of anesthesia you received.

Courtesy and professionalism of nursing staff toward you and your family member/caregiver.

Protection of confidentiality and personal privacy.

Degree to which your pain was controlled at our center.

Written instructions we understandable & explained well upon discharge.

Cleanliness and comfort of the facility.

Response to concerns/complaints, if any, during your visit.

Your overall experience and the care that you received at our facility.

Did you experiance any unexpected problems after your proceedure?

What did you like most about the facility?

Can we use the above quote as an anonymous testimonial on our site?

What did you like least about the facility?

Would you recommend this facility to your family and friends?

Type of procedure:

Date of procedure

Patient Name (optional)

Email

Physician's Name (optional)

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Patient Satisfaction Survey