| E-mail Address: * |
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| Full Name |
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| Indicate your overall impression of Spivey Station Surgery Center based upon the services you received during your outpatient visit. |
Excellent
Above Average
Average
Below Average
Poor |
| If your overall impression was not Excellent, what would it take to make it Excellent? |
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| Would you recommend the Spivey Station Surgery Center to a good friend who lives in the area, has a medical problem similar to yours and needs outpatient surgery? |
Yes
No
Not sure |
| If No or Not Sure, why? |
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Please Rate us on the following statements:
Pre-Surgery phone call instructions were clear
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Excellent
Above Average
Average
Below Average
Poor |
| Admissions person demonstrated courtesy and concern |
Excellent
Above Average
Average
Below Average
Poor |
| Billing and insurance information was clear |
Excellent
Above Average
Average
Below Average
Poor |
| Waiting time before being called to Pre-Op was reasonable |
Excellent
Above Average
Average
Below Average
Poor |
| Pre-Op personnel demonstrated courtesy and concern |
Excellent
Above Average
Average
Below Average
Poor |
| IV was administrated with minimal discomfort |
Excellent
Above Average
Average
Below Average
Poor |
| Clear instructions were provided prior to surgery |
Excellent
Above Average
Average
Below Average
Poor |
| Anesthesiologist demonstrated courtesy and concern |
Excellent
Above Average
Average
Below Average
Poor |
| Staff provided for your physical comfort in Pre-Op area |
Excellent
Above Average
Average
Below Average
Poor |
| Operating room nurses demonstrated courtesy and concern |
Excellent
Above Average
Average
Below Average
Poor |
| Staff explained the preperations for the surgical procedure |
Excellent
Above Average
Average
Below Average
Poor |
| Staff provided for your physical comfort |
Excellent
Above Average
Average
Below Average
Poor |
| Recovery room nurses demonstrated courtesy and concern |
Excellent
Above Average
Average
Below Average
Poor |
| Staff demonstrated concern for your privacy |
Excellent
Above Average
Average
Below Average
Poor |
| Staff provided for your physical comfort |
Excellent
Above Average
Average
Below Average
Poor |
| Staff provided sufficent recovery time prior to discharge |
Excellent
Above Average
Average
Below Average
Poor |
| Staff provided clear explanation of discharge instructions |
Excellent
Above Average
Average
Below Average
Poor |
| Did you observe staff members washing their hands during your care? |
Yes
No
Not sure |
| Did you observe staff members wearing gloves during your care? |
Yes
No
Not sure |
| Which member of our staff served you above and beyond the call of duty during your outpatient visit? If you provide names, we will make certain that they are recognized for their service to you. |
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| We welcome all comments, positive and negative. If you gave us a low grade or encountered difficulties with a staff member, we want to know what we can do to improve our services to you and others. |
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| * Required |
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