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Survey:

TELL US WHAT YOU THINK

Please rate our performance by checking the response that best describes your evaluation. Feel free to add comments. Thank you for your input and feedback.

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Please Rate The Following:
 
ADMITTING/REGISTRATION
Excellent
Good
Poor
Very Poor
   1. Professional and courteous service of office staff
   
   2. Speed and efficiency of registration
   
   3. Satisfactory answers to financial and insurance questions
NURSING
Excellent
Good
Poor
Very Poor
   
   4. Professional and courteous service or nurses
   
   5. Nurses introducing themselves and keeping you informed
   
   6. Nurses explaining procedures
   
   7. Satisfactory answers to your questions
   
   8. Written instructions for your home care
   
OVERALL
Excellent
Good
Poor
Very Poor
   
  9. Staff giving your the privacy you need
   
 10. Cleanliness and comfort of the Surgery Center
   
 11. Likelihood that you would return or recommend the Surgery Center
   
 12. OVERALL, rating of your experience at the Surgery Center
Name:
Email Address:
Additional Comments: