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1. Prior to my visit, I received all of the information I needed (e.g., how to prepare for my procedure)

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2. I knew where to go when I arrived at the hospital

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3. I felt welcomed and respected as a patient throughout my visit

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4. My privacy / confidentiality was respected at all times

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5. My surgery / procedure was explained to me in a way I could understand

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6. My anesthesia was explained to me in a way I could understand

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7. I was given clear discharge instructions (e.g., dietary or physical restrictions, new medications, symptoms to watch for, etc.,) to be able to manage post-operatively at home

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8. My questions were answered promptly and in a way I could understand

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9. I found the patient area to be comfortable and pleasant

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10. The Surgical Services area, and the hospital in general, was clean

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11. Overall impression of the quality of care you received

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12. Comments?

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