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Heathrow Surgery Center Patient Satisfaction Questionnaire
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)
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)
3.
Admission/Registration process on the day of your procedure.
Exceeded expectations
Met expectations
Below expectations
Other (please specify)
4.
Courtesy/Professionalism of the nursing staff.
Extremely professional
Very professional
Somewhat professional
Not so professional
Not at all professional
Other (please specify)
5.
Courtesy/Professionalism of your anesthesia provider.
Extremely professional
Very professional
Somewhat professional
Not so professional
Not at all professional
Other (please specify)
6.
All your questions were answered while at the Center.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Other (please specify)
7.
Courtesy/Professionalism of your physician.
Extremely professional
Very professional
Somewhat professional
Not so professional
Not at all professional
Other (please specify)
8.
The surgery center was clean and welcoming.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Other (please specify)
9.
Would you recommend our facility and services to a friend or family member?
Yes
No
Other (please specify)
10.
Please enter Surgeon's Name and Procedure Date.
Current Progress,
0 of 10 answered