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Patient Experience Survey
*
1.
Date of surgery
(Required.)
Please enter the date of your surgery
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
*
2.
Name of anaesthetist
(Required.)
Dr Paul Bertolino
Dr Martin Böhm
Dr Laurence Boss
Dr Andrew Chapman
Dr Andy Cluer
Dr Tim Cooper
Dr Mark Duncan
Dr David Goodie
Dr Mark Higney
Dr Cameron Hunt
Dr Gregory Kalogeropoulos
Dr Upendhar Kandala
Dr Navkiran Kaur
Dr Gerhard Labuschagne
Dr Benjamin Ma
Dr Elizabeth Mackson
Dr Joanne Momsen
Dr Anthony Notaras
Dr Melissa Oliver
Dr Neeraj Pal
Dr Angela Playoust
Dr Harry Prevedoros
Dr Pamela Salerno
Dr Ranald W Sharpe
Dr Karl Smolka
Dr James Tester
Dr Sue Ann Wan
Dr Chris Yong
*
3.
Please tell us your Gender
(Required.)
Male
Female
4.
What is your age?
18 to 24
Under 18 years of age
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
17%