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ESC-MT Patient Satisfaction Survey

Please tell us about your recent experience by rating us on the following items:
1.If you spoke with the surgery center by phone, how would you rate the helpfulness of the person you spoke with?
GREAT
GOOD
FAIR
OK
POOR
2.Appropriateness and accuracy of the information given during the pre-op call, including arrival time, directions, and preparation for the surgery.
GREAT
GOOD
FAIR
OK
POOR
3.Registration process on the day of surgery, including helpfulness of the front desk staff.
GREAT
GOOD
FAIR
OK
POOR
4.Total time in the facility - was it within the time frame that you were given?
GREAT
GOOD
FAIR
OK
POOR
5.Professionalism and courtesy of the center staff and anesthesia provider.
GREAT
GOOD
FAIR
OK
POOR
6.Cleanliness of the center and the comfort level of the patient/caregiver.
GREAT
GOOD
FAIR
OK
POOR
7.How well were your questions and concerns addressed on the day of surgery?
GREAT
GOOD
FAIR
OK
POOR
8.Quality of discharge teaching and post-op instructions.
GREAT
GOOD
FAIR
OK
POOR
9.How would you rate your overall experience?
GREAT
GOOD
FAIR
OK
POOR
10.What is the likelihood that you would recommend the center to others?
11.We appreciate any additional feedback on services provided by our staff. If one of our team members made an impression, please share:
12.Patient's Surgeon (Optional):
13.Patient Contact Information (Optional):
14.Date(s) of Service (Optional):
200%