Thank you for using our Surgical Services at ESH. We realize that you have many choices available to you when making health care choices for you and your family. We appreciate the fact you chose our hospital and want to make sure your visit met or exceeded your expectations. Please take a moment to complete this brief survey.

Your thoughts will help us provide better service to all of our patients in the future!

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* 1. Please indicate the correct answer.

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* 2. What type of surgery did you have?

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* 3. Did your surgeon perform your surgery with the da Vinci Robotic System?

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* 4. Would you choose our surgical department again?

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* 5. Would you recommend our surgical department to your family and friends?

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* 6. The ease and convenience of scheduling your appointment was:

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* 7. When scheduling your surgery, was the scheduler polite and respectful?

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* 8. Was your Pre Op nurse polite and respectful?

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* 9. Please rate the service you received from Admitting/Registration.

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* 10. Members of your family and/or friends were served satisfactorily by our staff. 

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* 11. After the registration process, your wait time to be seen by a nurse was: 

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* 12. Did your nurse explain things in a way you could understand?

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* 13. Did your doctor explain your surgery in a way that you could understand?

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* 14. Instructions prior to your surgery were:

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* 15. Your pain was adequately managed/treated:

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* 16. Adequate precautions were taken for your safety:

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* 17. During your visit, how often did staff maintain your privacy?

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* 18. If you were discharged the same day as your surgery, were your discharge instructions clear?

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* 19. What was your overall opinion of our surgical services?

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* 20. Was this your first visit to our hospital?

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* 21. Comments:

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* 22. Date of visit (optional)

Date

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* 23. Contact information (optional)

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* 24. Gender identity (optional)

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* 25. Age (optional)

T