Patient Satisfaction Survey

  • 1. Were the instructions you received prior to surgery helpful?
  • 2. Were your financial responsibilities discussed and your questions answered?
  • 3. Was the waiting time prior to surgery as expected and reasonable?
  • 4. Was the facility clean and well kept?
  • 5. Was the staff courteous and friendly?
  • 6. Was your privacy respected at all times?
  • 7. Was your pain level as expected and well controlled?
  • 8. Was adequate time allowed for your recovery?
  • 9. Were your homecare instructions clear and helpful?
  • 10. Did you feel safe at the facility?
  • 11. Overall, do you feel you received quality healthcare at the facilities?
  • 12. Date of Service
  • 13. Comments
  • 14. Date of Birth
  • 15. Patient Name

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