Dear Patient,

At Barrie Endoscopy, we are committed to providing you with the best possible healthcare. We are interested in knowing what you think about our services. You can help us evaluate our performance by completing this brief (5 minute) survey regarding your visit.

Thank you for taking time to share your experience with us.

* 1. Please tell us the date of your procedure

Date / Time

* 2. If you spoke to the facility by phone, how helpful was the person you spoke with?

* 3. Ease of scheduling your procedure

* 4. The ease of the check-in process

* 5. The comfort, cleanliness, and amenities of the facility

* 6. Clear and sufficient instructions on what to do and what to expect before your procedure

* 7. The wait time in our facility, compared to your expectations

* 8. The courtesy and caring of your physician

* 9. The courtesy and caring of the nursing and support staff

* 10. Skills of assisting staff (i.e anesthesiologist)

* 11. Comfort level within the procedure room

* 12. Usefulness of the information provided about what was done during the procedure

* 13. Clear and sufficient instructions on what to do and what to expect after your procedure

* 14. Overall, how would you rate the teamwork between the doctors, nurses and other staff?

* 15. Overall, how satisfied were you with the procedure experience?

* 16. Was this your first visit as a patient to our facility?

* 17. Would you recommend our facility to others?

* 18. Please add any comments you have regarding your experience? Please feel free to tell us on ways that you feel we could improve our services and the overall experience of our patients.

T