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Patient Satisfaction Survey

The procedure was discussed to my satisfaction prior to the surgery *

Excellent

Good

Fair

Poor

The date and time of the procedure was clearly reviewed. *

Excellent

Good

Fair

Poor

The environment was comfortable and organized. *

Excellent

Good

Fair

Poor

The surgery proceeded on time. *

Excellent

Good

Fair

Poor

Information about post-operative care was clearly discussed. *

Excellent

Good

Fair

Poor

The facility’s hours were convenient. *

Excellent

Good

Fair

Poor

The staff was courteous and professional. *

Excellent

Good

Fair

Poor

The staff was available to answer questions. *

Excellent

Good

Fair

Poor

The staff was available to answer questions. *

Excellent

Good

Fair

Poor

The procedure was discussed to my satisfaction prior to the surgery *

Excellent

Good

Fair

Poor

The pre-operative instructions were clear. *

Excellent

Good

Fair

Poor

The pre-operative teaching was helpful. *

Excellent

Good

Fair

Poor

The anesthesia was explained to my satisfaction. *

Excellent

Good

Fair

Poor

My overall anesthesia experience was as I expected. *

Excellent

Good

Fair

Poor

Would you recommend our facility to family and/or friends? *

Yes

No

What did you like most about our facility? *

What did you like least about our facility? *

How did you learn about our facility? *

Were there any problems that you did not anticipate?

Please give two suggestions as to how we may improve our service to our patients.

Name (Optional)

Date of Surgery (optional)

If you are human, leave this field blank.

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Please complete a “Patient Satisfaction Survey” after your surgical visit located under the “Patient Info” tab.

October 17, 2017

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Tri-State Surgical Center

Phone: (304) 267-0556

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