Patient Experience Survey

It was our pleasure to serve you. Please let us know what you think about the service received. Please answer the questions
below using the 1-10 scale, Where 10 means "Extremely Likely" and 0 means "not at all likely
 

* 1. How Likely is it that you would recommend Southeastern Surgery Center to family and friend? 

0 Score 0-10 10
Clear
i We adjusted the number you entered based on the slider’s scale.

* 2. What is the most important improvement that would make you rate us closer to a ten?

* 3. Please rate the personal interest shown to you by the Southeastern Surgery Center Personnel?

0 Score 01-10 10
Clear
i We adjusted the number you entered based on the slider’s scale.

* 4. What did you like most about Southeastern Surgery Center?

* 5. Please list any general comments, suggestions, or employees who provided exceptional service:

* 6. Date of Procedure

Date / Time

T