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Patient Survey

Share your thoughts with us. Please take a moment to tell us how we’re doing. We hope you are pleased with your care and we are eager to learn about areas where we can improve.

1. Was this your first visit?

2. Which Doctor did you visit?














3. Why did you decide to seek medical treatment at our office? Check all that apply.







3. How did you hear about the Orthopedic Surgery Center?








For questions 4 - 12, please give us a grade in each of the following areas, use the following grading scale:
A=Excellent, B=Above Average, C=Average, D=Needs Improvement, F=Poor

4. When I received my preanesthesia/preadmission phone call, my questions were answered satisfactorily.

5. I felt my personal information was kept private and confidential.

6. When I arrived, the reception desk staff was helpful and courteous.

7. The waiting areas were clean with available and comfortable seating.

8. The wait time before surgery was reasonable.

9. The nurses were helpful and courteous.

10. Anesthesia staff were courteous and answered all questions about anesthesia satisfactorily.

11. I was satisfied with the treatment I received.

12. My family and I understood the instructions we received at discharge and they were helpful.

13. Did you receive a pre-surgery envelope?

14. Was the information packet helpful?

15. What did you like least about your experience?

16. What could we have done to make your experience better?

17. May we use your comments on our website?

18. May we use your name (First Initial, Last Name) on our website? If so, please type in blank.


19. Would you like a phone call regarding a concern you have? If so, please type your phone number in the blank.

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