Patient Satisfaction Questionnaire

1. How helpful was the phone call prior to your surgery? 1. How helpful was the phone call prior to your surgery? Excellent Good Fair Poor

2. How satisfied were you with the answers to your billing and insurance questions? 2. How satisfied were you with the answers to your billing and insurance questions? Excellent Good Fair Poor

3. Did the staff treat you with courtesy? 3. Did the staff treat you with courtesy? Excellent Good Fair Poor

4. Was the staff available to answer questions and explain procedures? 4. Was the staff available to answer questions and explain procedures? Excellent Good Fair Poor

5. Did the staff demonstrate concern for your comfort and personal safety? 5. Did the staff demonstrate concern for your comfort and personal safety? Excellent Good Fair Poor

6. Were you satisfied by your treatment with all departments? 6. Were you satisfied by your treatment with all departments? Excellent Good Fair Poor

7. Were your discharge instructions explained clearly? 7. Were your discharge instructions explained clearly? Excellent Good Fair Poor

8. Did you recieve a follow-up phone call within 3 business days? 8. Did you recieve a follow-up phone call within 3 business days? Excellent Good Fair Poor

9. Would you recommend our facility to a family member or a friend? 9. Would you recommend our facility to a family member or a friend? Excellent Good Fair Poor

10. If we choose to, may we have your premission to publish any comments or concerns, including your name, from your survey? 10. If we choose to, may we have your premission to publish any comments or concerns, including your name, from your survey? Yes No

Do you have any comments you would like to share with our facility?