Englewood Endoscopic Associates
420 Grand Avenue Englewood, NJ 07631 201-569-7044
Patient Satisfaction Survey
We want to thank you for giving us the opportunity to care for you. It is important to us know how our care impacted on you and your guests. Your input is greatly appreciated, and we would like to request a few minutes of your time to fill out the following survey.
Thank you.
Name:
Registration:
1. Was the center easy to locate?
Yes
No
2. Was the registration process easy and friendly?
Yes
No
3. Was the registration staff courteous, helpful and friendly?
Yes
No
4. Was the waiting area comfortable?
Yes
No
5. Were your guest and/or family kept informed of your progress?
Yes
No
Before Surgery:
1. Preoperative instructions were provided:
Doctor's Office
Surgery Center
2. Was the preoperative communication with the Surgery Center helpful?
Yes
No
3. Were all your questions answered satisfactorily?
Yes
No
Pre-Operation:
1. Was the pre-op area comfortable?
Yes
No
2. Was the pre-op staff courteous, helpful and friendly?
Yes
No
Procedure Room:
1. Did the staff make you feel comfortable and at ease with your procedure?
Yes
No
2. Was the staff courteous, helpful and friendly?
Yes
No
Recovery/Discharge:
1. Were your questions answered to your satisfaction?
Yes
No
2. Were the questions about your procedure and follow-up care helpful?
Yes
No
Additional comment:
3. Was the staff in this area courteous, helpful and friendly?
Yes
No
4. Was the follow-up call helpful and reassuring?
Yes
No
5. Overall, was your experience with the Surgery Center positive?
Yes
No
6. How can we improve our service?
Additional comments or feedback :
Survey completed by:
Patient
Other :
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