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* 2. PLEASE RESPOND TO THE FOLLOWING QUESTIONS

  GREAT GOOD OK FAIR POOR
Ease of scheduling your surgery 
Quality and efficiency of check-in process 
Courtesy and care of your physician
Satisfaction with your anesthesia care provider 
Courtesy and care of nursing staff
Clear instructions were given for post-operative care 
Comfort and cleanliness of our surgery center 
Confidence in your overall surgical experience 

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* 3. Financial obligations were communicated clearly

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* 4. Clear instructions were given for pre and postoperative care

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* 5. Additional comments regarding your surgery day:

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* 6. How likely are you to recommend our Surgery Center to a colleague, friend or family member?

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* 7. I hereby grant permission for AESC to use my comments for marketing and/or online

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