Heathrow Surgery Center Patient Satisfaction Questionnaire

Question Title

* 1. Instructions given during the preoperative phone call from a nurse at the surgery center were thorough and clear.

Extremely clear

Very clear

Somewhat clear

Not so clear

Not at all clear

Other (please specify)

Question Title

* 2. Discharge instructions given by the Post-Op Nurse for follow-up care after your procedure were thorough and clear.

Extremely clear

Very clear

Somewhat clear

Not so clear

Not at all clear

Other (please specify)

Question Title

* 3. Admission/Registration process on the day of your procedure.

Exceeded expectations

Met expectations

Below expectations

Other (please specify)

Question Title

* 4. Courtesy/Professionalism of the nursing staff.

Extremely professional

Very professional

Somewhat professional

Not so professional

Not at all professional

Other (please specify)

Question Title

* 5. Courtesy/Professionalism of your anesthesia provider.

Extremely professional

Very professional

Somewhat professional

Not so professional

Not at all professional

Other (please specify)

Question Title

* 6. All your questions were answered while at the Center.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Other (please specify)

Question Title

* 7. Courtesy/Professionalism of your physician.

Extremely professional

Very professional

Somewhat professional

Not so professional

Not at all professional

Other (please specify)

Question Title

* 8. The surgery center was clean and welcoming.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Other (please specify)

Question Title

* 9. Would you recommend our facility and services to a friend or family member?

Yes

Other (please specify)

Heathrow Surgery Center Patient Satisfaction Questionnaire

Question Title

* 1. Instructions given during the preoperative phone call from a nurse at the surgery center were thorough and clear.

Question Title

* 2. Discharge instructions given by the Post-Op Nurse for follow-up care after your procedure were thorough and clear.

Question Title

* 3. Admission/Registration process on the day of your procedure.

Question Title

* 4. Courtesy/Professionalism of the nursing staff.

Question Title

* 5. Courtesy/Professionalism of your anesthesia provider.

Question Title

* 6. All your questions were answered while at the Center.

Question Title

* 7. Courtesy/Professionalism of your physician.

Question Title

* 8. The surgery center was clean and welcoming.

Question Title

* 9. Would you recommend our facility and services to a friend or family member?

Question Title

* 10. Please enter Surgeon's Name and Procedure Date.