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» YOUR FIRST VISIT   » ADMITTING   » SURGERY   » AFTER SURGERY   » PATIENT FORMS   » PAYMENT POLICY   » PRIVACY POLICY	Patient Satisfaction Survey Dear Patient: Your feelings about the services you received at our surgery Center are important to us. Please help us better serve you by filling out this brief questionnaire. Thank you. Name: (Optional) Address: (Optional)     ADMITTING/REGISTRATION Was the office staff professional and courteous? Select One Very Good Good Poor Very Poor Was the packet with information provided before your procedure understandable? Select One Very Good Good Poor Very Poor Was the check-in process speedy and efficient? Select One Very Good Good Poor Very Poor Were all your financial or insurance questions answered to your satisfaction? Select One Very Good Good Poor Very Poor     NURSING DEPARTMENT   Was your nurse professional and courteous? Select One Very Good Good Poor Very Poor Did the nurses introduce themselves? Select One Very Good Good Poor Very Poor Were you given the privacy you needed? Select One Very Good Good Poor Very Poor Were procedures/tests explained to you before they were done? Select One Very Good Good Poor Very Poor Were all your questions answered to your satisfaction? Select One Very Good Good Poor Very Poor Was the Surgery Center clean and comfortable? Select One Very Good Good Poor Very Poor Did you feel that your pain level was handled adequately? Select One Very Good Good Poor Very Poor Was access to the Center easy? Select One Very Good Good Poor Very Poor Do you feel confident and have trust in your Physician? Select One Very Good Good Poor Very Poor     OVERALL   How would rate your experience at the Surgery Center? Select One Very Good Good Poor Very Poor     Additional Comments
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