Post Operative Patient Satisfaction Survey

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* 1. Date Of Service

DOS

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* 2. Facility

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* 3. Status

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* 4. ECD

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* 5. Anesthesia Type

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* 6. Did an Anesthesiologist speak with your BEFORE your procedure?

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* 7. Did they explain in detail and to your satisfaction what they were going to do DURING your procedure?

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* 8. Did an anesthesiologist explain what to expect AFTER your procedure?

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* 9. On a scale of 1-10 please rate your anesthesia experience.

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* 10. Did your anesthesia team show compassion and understanding towards your concerns?

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* 11. Please explain any complications you may have had with our anesthesia team and what we may do to improve the quality of care we deliver to you the patient.

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