Form 1 Anonymous Patient Survey Dear Patient: 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. Professional and courteous office staffExcellentGoodPoorVery PoorSpeed and efficiency of registrationExcellentGoodPoorVery PoorSatisfactory answers to financial and insurance questionsExcellentGoodPoorVery PoorProfessional and courteous service of nursesExcellentGoodPoorVery PoorNurses introducing themselves and keeping you informedExcellentGoodPoorVery PoorNurses explaining proceduresExcellentGoodPoorVery PoorSatisfactory answers to questionsExcellentGoodPoorVery PoorWritten instructions for your home careExcellentGoodPoorVery PoorStaff giving you the privacy you neededExcellentGoodPoorVery PoorCleanliness and comfort of the Surgery CenterExcellentGoodPoorVery PoorLikelihood that you will return or recommend the Surgery Center to othersExcellentGoodPoorVery PoorOverall, rate your experience at the Surgery CenterExcellentGoodPoorVery PoorWould you like us to contact you to discuss any issues? (Optional)YesNoName First Last Phone*
