ESC-MT PATIENT SATISFACTION SURVEY

OUR FACILITY 1-4
REGISTRATION 5-7
PRE-OP 8-11
OPERATING/PROCEDURE ROOM 12-13
POST OPERATIVE/RECOVERY 14-16
OVERALL EXPERIENCE 17

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* 1. Convenience of center's location

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* 2. Signage and directions easy to follow

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* 3. Cleanliness of center

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* 4. Comfort of waiting room

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* 5. Friendliness of staff

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* 6. Speed of registration process

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* 7. Time in waiting room

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* 8. Professionalism and courtesy of pre-op staff

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* 9. Appropriate & complete information given at pre-op phone call

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* 10. Answered your questions and addressed your concerns

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* 11. Waiting time prior to going into operating room

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* 12. Professionalism and courtesy of staff (nurses/doctor)

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* 13. Comfort of operating room

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* 14. Professionalism and courtesy of staff

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* 15. Written instructions were understandable/explained well

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* 16. All questions were answered

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* 17. Overall patient and family experience at Eye Surgery Center of MT?

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* 18. Please circle the physician who provided care to you this visit:

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* 19. Name (Optional): 

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* 20. Phone Number (Optional):

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* 21. Date of Service (Optional):

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* 22. Comments:

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100% of survey complete.

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