Dear Patient, Thank you for choosing Premier Surgical. Your feedback is important to us. Please complete this brief survey about your experience. To enter the $100 VISA gift card drawing, please enter your email at the end of the survey. Thank you!

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* 1. Which Premier Surgical provider did you see?

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* 2. Which Premier Surgical office did you visit?

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* 3. How would you rate the ability to make a timely appointment with your surgeon or provider?

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* 4. How would you rate the amount of time you spent in the office waiting room?

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* 5. How would you rate the amount of time you spent in the exam room?

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* 6. How well did your Premier Surgical Physician explain your procedure and answer your questions?

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* 7. Did you have a surgery or procedure? If No, please skip to Question 10.

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* 8. If you had surgery or a procedure, did you receive educational material about the procedure before your surgery?

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* 9. If you had surgery or a procedure, did you receive Pre-op or Discharge instructions?

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* 10. How would you rate the courtesy and professionalism of the Premier Surgical nursing personnel you encountered?

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* 11. How would you rate the courtesy and professionalism of the Premier Surgical office staff you encountered?

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* 12. If you had an Ultrasound exam at a Premier Surgical office (not in a hospital), how do you rate the courtesy and professionalism of the Premier Ultrasound Tech?

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* 13. Did you contact the Premier Surgical Billing Office about a billing or insurance issue? If NO, please skip to Question 14.

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* 14. If you DID talk to the Premier Surgical Billing Office, how would you rate the courtesy and professionalism of the Billing staff member?

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* 15. How would you rate the cleanliness and comfort of the Premier Surgical office you visited?

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* 16. Overall, how would you rate your experience with the Premier Surgical office you visited?

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* 17. Would you recommend Premier Surgical to your family or friends?

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* 18. What could we have done better to improve your experience with Premier Surgical?

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* 19. If there was a Premier Surgical physician or staff member who left a positive impression on you, please tell us about it.

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* 20. Please enter your email if you would like to be entered in the drawing for a $100 VISA gift card.

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