Patient Satisfaction Survey

Name (optional)

Surgeon:
Select a SurgeonBarnett, MDBarton, DPMCooper, MDCosta, DOCreech, MDDomenick, MDDushuttle, MDFalvello, DOFeuerstein, MDGillespie, MDGriesser, DPMHartmann, MDIrgau, MDKim, MDKrishnan, MDKurpad, MDLawton, DPMLee, MDManifold, MDMavrakakis, MDMiller, MDMoylan, MDPan, MDPeters, MDPiccioni, MDScacheri, MDSchwartz, MDSeiff, MDSingh, MDSmith, DOSpana, MDSuh, MDSwaminathan, MDTam, DPMTooze, MDVallorosi, MDWong, MDWynn, MDZaragoza, MD

Procedure Type:

Date of Surgery

Please Rate The Following

Surgeon:

How satisfied were you with the amount of time it took the surgeon's office to schedule your procedure?
ExcellentGoodFairPoor

How satisfied were you with the care provided by your surgeon while at the center?
ExcellentGoodFairPoor

Facility

How would you rate the pre-op instruction given to you by our staff prior to your procedure?
ExcellentGoodFairPoorNA

How satisfied were you with the interaction or your care you received from the following departments:

Pre Anesthesia Nursing/One Medical Passport Online

ExcellentGoodFairPoorNA

Anesthesia Staff

ExcellentGoodFairPoor

Registration/ Reception

ExcellentGoodFairPoor

Preop (area before surgery)

ExcellentGoodFairPoor

Operating Room

ExcellentGoodFairPoor

Recovery Room (area after surgery)

ExcellentGoodFairPoor

Billing Staff

ExcellentGoodFairPoor

How well did we keep you informed if there was a delay in our schedule that increased your preop wait time?
ExcellentGoodFairPoorNA

Do you feel that you or your responsible adult received adequate: If NA, please comment below:

Post operative teaching?

ExcellentGoodFairPoorNA

Discharge instructions?

ExcellentGoodFairPoorNA

Review of new and old medications?

ExcellentGoodFairPoorNA

How would you rate the level at which your post-op pain was controlled in recovery?
ExcellentGoodFairPoorNA

How would you rate our treatment areas, were they clean and comfortable?
ExcellentGoodFairPoor

How would you rate your overall satisfaction with your surgical experience?
ExcellentGoodFairPoorNA

Please answer "Yes" or "No" to the following:

Did you observe the staff performing hand hygiene before and after taking care of you?
YesNo

Do you feel your privacy was protected? If no, please comment below.
YesNo

Do you feel our staff was courteous, knowledgeable, and quick to respond to your needs?
YesNo

Did you receive a post-op call from a nurse within 1-2 business days of your procedure? Monday - Friday, except holidays (example: Friday patients will be contacted on Monday)
YesNo

Did you have to contact your surgeon for any reason, other than your routine follow up appointment? If yes, please comment below.
YesNo

Did you experience a surgical complication as a result of your surgery, or has your doctor prescribed an antibiotic for a surgical site infection? If yes, please explain below.
YesNo

Did you experience nausea or vomiting while at the surgery center?
YesNo

Did you experience nausea and vomiting after discharge or within 24 hrs of leaving the surgery center?
YesNo

Would you recommend the Surgery Center to your family and friends?
YesNo

If you would like to speak to the Administrator regarding your visit or care at the facility, please call 302-736-3710. Thank you for taking the time to complete our survey; we look forward to your feed back. If you have any additional comments or suggestions, please feel free to type them below.

Additional Comments