MICHIANA SURGERY CENTER PATIENT SURVEY Question Title * 1. How likely is it that you would recommend Michiana Surgery Center to a friend or colleague? Very likely Likely Somewhat likely Unlikely Never Question Title * 2. Overall, were you satisfied with the efficiency of the check in process? Extremely satisfied Moderately satisfied Neither satisfied nor dissatisfied Moderately dissatisfied Question Title * 3. During your most recent visit, did receptionists and staff at Michiana Surgery Center treat you with courtesy and respect? Yes, definitely Yes, somewhat No Question Title * 4. During your most recent visit, did Dr. Pai spend enough time with you explaining your procedure? Yes, definitely Yes, somewhat No Question Title * 5. During your most recent visit, did Dr. Pai explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No Question Title * 6. Did you receive post operative instructions after your procedure? Yes No Question Title * 7. Cleanliness of the facility? Great Good Ok Fair Poor Question Title * 8. Overall, how would you rate the treatment and care received from the medical staff? Great Good Ok Fair Poor Question Title * 9. How long of a wait did you experience before your procedure was performed? 5-10 minutes 10-20 minutes 20-30 minutes More than 30 minutes Question Title * 10. Do you have any other comments, questions or concerns? / Suggestions for improvement. No If Yes, please explain: Done