Patient Satisfaction Survey Question Title * 1. How would you rate the customer service of the staff at ADS? Excellent Fair Needs Improvement Question Title * 2. Did you feel comfortable during your time at ADS and that any concerns you may have had were addressed? Always Usually Sometimes Rarely Never Question Title * 3. I feel communication was clear and I was included in the decision making for my procedure where applicable? Always Usually Sometimes Rarely Never Question Title * 4. Do you feel your privacy was respected? Yes, at all times Sometimes Needs Improvement Question Title * 5. Was the time you waited for your procedure.. Good Fair Needs improvement Question Title * 6. Did you receive Informed Financial Consent on the day of your surgery? Yes No Question Title * 7. How would you rate the refreshments provided? Excellent Fair Needs Improvement Question Title * 8. How would you rate the noise level? Very Quiet Fair Too Noisy Question Title * 9. How would you rate the cleanliness of the environment? Very Clean Fair Needs Improvement Question Title * 10. How would you rate the comfort of the environment? Very Comfortable Fair Needs Improvement Question Title * 11. What are we doing well? Question Title * 12. What could we do better? Question Title * 13. Did we meet your expectations? Yes No Other (please specify) Question Title * 14. Would you like to be contacted regarding your survey? if so please leave your Name and contact Number? Done
