* 1. Please respond to the following questions:

  Yes No
Did Dr. Finkle discuss your surgical procedure to your satisfaction?
Were you well informed of the date and time of your procedure?
Were your family members/driver informed where he/she could wait and did they find the surroundings comfortable?
Was the environment comfortable and organized?
Did the staff make themselves available to answer your questions and explain procedures?
Did you and your family have a clear understanding of what to do when you returned home to continue recuperation from your surgery?
After surgery, did you feel you and those caring for you were given enough information on where to get assistance, if needed?
Is the location convenient and readily accessible?

* 2. How long were you at the facility?

* 3. What did you like most about the facility?

* 4. What did you like least about the facility?

* 5. Would you recommend Finkle Cosmetic Surgery Center to your family and friends?

* 6. Please rate the following:

  Excellent Good Fair Poor
Courtesy of staff
Professionalism of staff
Efficiency of staff
Effectiveness of Pre-operative teaching
Effectiveness of Post-operative teaching

* 7. Which procedure(s) was performed? (Please check all that apply)

* 8. Please use the space below to add any comments you may have.

* 9. Date of Procedure

* 10. Name (optional)