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AQI Olympic Anesthesia Patient Satisfaction Survey NEW

Olympic Anesthesia Patient Satisfaction Survey

At Olympic Anesthesia our patients are important to us and this survey is intended to help us determine what we are doing well and where we can improve. Please take a moment to tell us about your recent anesthesia experience. We will keep your responses private and only use them to better our practice. If you would rather take this survey on line please access it on our website: www.olympicanesthesia.com/patient/survey
Please note that St. Michael Medical Cntr. was formerly named Harrison Medical Center. Thank you for your time.
1.Please tell us a few things about your recent procedure...
2.What facility did your procedure take place at? (Please Check One)(Required.)
3.During your visit with the anesthesia provider (before surgery) how satisfied were you with the amount of information you were given & the answers to your questions?
4.How satisfied were you with the response by the anesthesia team to your comfort and well-being?
5.How likely are you to recommend your ANESTHESIA PROVIDER(S) to a friend or family member?
6.How would you rate your overall ANESTHESIA experience?
7.How satisfied were you with the ability of the anesthesia team to control your pain after surgery?
8.At DISCHARGE how would you rate your pain level? 0 = NO PAIN & 10 = Worst Pain Ever
0
1-2
3-4
5-6
7-8
9-10
9.After you left the recovery room or returned home...
No
Yes
Did you experience nausea?
Did you vomit at any time?
10.Did you experience any unexpected events related to your anesthesia care?
11.Internal use only (Not to be filled in by patient)