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