Patient Satisfaction Survey

Gramercy Surgery Center

Thank you for taking the survey. Your feedback is important to us.

Question Title

* 1. At which center did you have your procedure(s)?

Manhattan site (380 Second Avenue, Suite 1000, New York, NY10010)

Queens site (59-25 Kissena Blvd, Flushing, NY11355)

Both sites

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* 2. Please evaluate your reception at the center and the quality of your care.

	Excellent	Good	Adequate	Poor	Unacceptable	N/A
Was the office staff courteous when you called the center?	Was the office staff courteous when you called the center? Excellent	Was the office staff courteous when you called the center? Good	Was the office staff courteous when you called the center? Adequate	Was the office staff courteous when you called the center? Poor	Was the office staff courteous when you called the center? Unacceptable	Was the office staff courteous when you called the center? N/A
Was the registration staff helpful when you arrived?	Was the registration staff helpful when you arrived? Excellent	Was the registration staff helpful when you arrived? Good	Was the registration staff helpful when you arrived? Adequate	Was the registration staff helpful when you arrived? Poor	Was the registration staff helpful when you arrived? Unacceptable	Was the registration staff helpful when you arrived? N/A
Did the nursing staff demonstrate continuous concern for your care and comfort?	Did the nursing staff demonstrate continuous concern for your care and comfort? Excellent	Did the nursing staff demonstrate continuous concern for your care and comfort? Good	Did the nursing staff demonstrate continuous concern for your care and comfort? Adequate	Did the nursing staff demonstrate continuous concern for your care and comfort? Poor	Did the nursing staff demonstrate continuous concern for your care and comfort? Unacceptable	Did the nursing staff demonstrate continuous concern for your care and comfort? N/A
Was your privacy respected at all times?	Was your privacy respected at all times? Excellent	Was your privacy respected at all times? Good	Was your privacy respected at all times? Adequate	Was your privacy respected at all times? Poor	Was your privacy respected at all times? Unacceptable	Was your privacy respected at all times? N/A
Did our pre-operative instructions adequately prepare you for your surgical visit?	Did our pre-operative instructions adequately prepare you for your surgical visit? Excellent	Did our pre-operative instructions adequately prepare you for your surgical visit? Good	Did our pre-operative instructions adequately prepare you for your surgical visit? Adequate	Did our pre-operative instructions adequately prepare you for your surgical visit? Poor	Did our pre-operative instructions adequately prepare you for your surgical visit? Unacceptable	Did our pre-operative instructions adequately prepare you for your surgical visit? N/A
Were you fully informed and satisfied with your anesthesia experience?	Were you fully informed and satisfied with your anesthesia experience? Excellent	Were you fully informed and satisfied with your anesthesia experience? Good	Were you fully informed and satisfied with your anesthesia experience? Adequate	Were you fully informed and satisfied with your anesthesia experience? Poor	Were you fully informed and satisfied with your anesthesia experience? Unacceptable	Were you fully informed and satisfied with your anesthesia experience? N/A
Do you feel the discharge instructions have prepared you for your recuperation at home?	Do you feel the discharge instructions have prepared you for your recuperation at home? Excellent	Do you feel the discharge instructions have prepared you for your recuperation at home? Good	Do you feel the discharge instructions have prepared you for your recuperation at home? Adequate	Do you feel the discharge instructions have prepared you for your recuperation at home? Poor	Do you feel the discharge instructions have prepared you for your recuperation at home? Unacceptable	Do you feel the discharge instructions have prepared you for your recuperation at home? N/A
Were you comfortable with the appearance and cleanliness of the center?	Were you comfortable with the appearance and cleanliness of the center? Excellent	Were you comfortable with the appearance and cleanliness of the center? Good	Were you comfortable with the appearance and cleanliness of the center? Adequate	Were you comfortable with the appearance and cleanliness of the center? Poor	Were you comfortable with the appearance and cleanliness of the center? Unacceptable	Were you comfortable with the appearance and cleanliness of the center? N/A

Comments (Optional)

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* 3. How would you rate the overall experience you have with us?

Excellent

Good

Adequate

Poor

Unacceptable

Other (please specify)

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* 4. Please answer the following questions regarding your well-being after your procedure(s).

	Yes	No
Did you experience any dizziness, nausea, or bowel disturbances?	Did you experience any dizziness, nausea, or bowel disturbances? Yes	Did you experience any dizziness, nausea, or bowel disturbances? No
If yes, please explain.
Did you experience any problems as urinating?	Did you experience any problems as urinating? Yes	Did you experience any problems as urinating? No
If yes, please explain.

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* 5. Would you choose to return to Gramercy Surgery Center if required another procedures in the future?

Yes

No

Yes

No

Question Title

* 6. How likely is it that you would recommend Gramercy Surgery Center to a friend or colleague?

Not at all likely

Extremely likely

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* 7. Do you have any suggestions on how we could improve the services we provide to you?

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* 8. Your Name (Optional)

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* 9. The Date of Your Visit (Optional)