St. John's Surgery Center
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St. John's Surgery Center - Questions
St. John's Surgery Center - Questions
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Patient Satisfaction Survey
We would like to know how you feel about the quality of our care that you received today. Your responses are directly responsible for improving our services. All responses will be kept confidential and anonymous. Thank you for your time.



Date of Service :


Reception Area:

There was someone at the desk to greet you.

Great
Good
OK
Fair
Poor


Courtesy of the staff member.

Great
Good
OK
Fair
Poor


Personal information kept private.

Great
Good
OK
Fair
Poor


Pre-op Area:

The competence/concern of the nurses who cared for you.

Great
Good
OK
Fair
Poor


Privacy

Great
Good
OK
Fair
Poor


The concern of the nurse anesthetist.

Great
Good
OK
Fair
Poor


The explanation of your "sedation" and questions answered.

Great
Good
OK
Fair
Poor


Post-op Area:

Review of your discharge instructions.

Great
Good
OK
Fair
Poor


The competence/concern of the recovery staff.

Great
Good
OK
Fair
Poor


Your concerns & questions answered.

Great
Good
OK
Fair
Poor


Facility:

Neat and clean building.

Great
Good
OK
Fair
Poor


Comfort & Safety while waiting.

Great
Good
OK
Fair
Poor


The likelihood of referring your friends and relatives to us:

Great
Good
OK
Fair
Poor



What do you like best about our center?



What do you like least about our center?



Suggestions for improvement?



Was there a staff member that was particularly helpful?



Would you like someone to contact you about your experience at St. John's? If so, please complete the following:

Name ..................:
Phone .................:




Thank you for completing our Survey!



Please press "Submit" button only once.


Note: This unsecured form is automatically submitted by your email, so please do not include any sensitive information like credit card numbers, etc.





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