Day Surgery Survey

We have tried to make your visit to Dayton Children's Day Surgery Department as pleasant and efficient as possible. Your complete satisfaction is our goal. To help us evaluate and improve our services, we need your feedback.

Please rate the following services you or your child received by checking the response that best represents your feeling. Also, please comment on any good or bad experiences you may have had during this visit. Thank you!
1. Ease of locating Dayton Children's Day Surgery Department?
2. Courtesy and efficiency of the clerk who registered you and your child?
3. Satisfaction with length of time before going to surgery?
4. Cleanliness of the Day Surgery Department?
5. Availability of books/toys/video games/other activities for your child?
Comments (please describe good or bad experiences)
6. How well the nurses listened to you and kept you informed?
7. How well the nurses relieved your child’s fears?
8. How well the anesthesiologist listened to you and answered your questions?
9. How well the surgeon listened to you and answered your questions?
10. Courtesy and efficiency of the staff who took your child’s blood?
Comments (please describe good or bad experiences)
11. Overall, how well the staff introduced themselves?
12. How well the staff explained any delays you may have experienced?
13. Clarity of your pre-surgery instructions?
14. Helpfulness of the Pre-Surgery Clinic (if attended for anesthesia evaluation)?
15. How well your child’s pain was controlled?
16. Satisfaction with your child’s recovery period before leaving the hospital?
17. Your understanding of the follow-up care required for your child at home?
18. Helpfulness of follow-up telephone call after surgery?
19. Overall quality of the care your child received at Dayton Children's Day Surgery Department?
20. Likelihood of recommending Dayton Children's Day Surgery department to others?
Comments/suggestions for improvement (please be specific)
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