Patient Survey
 

We would appreciate if you would take a moment to complete this questionnaire. We value your opinion as your comments will help us to improve service for you and your family.

Thank you in advance for your comments!
 
Name: (Optional)
Email Address: (Required)
Physician: (Required)
Date of Procedure: (Required)
   
Did the nurse from the Reading Surgery Center explain your preoperative instructions in a manner you understood and were they consistent with those given by your doctor’s office? Yes  No
COMMENTS: 
If you were contacted by our billing office prior to your procedure to discuss your financial arrangements, was it done in a professional and courteous manner?
 Yes  No
COMMENTS: 
Were you treated professionally and courteously by the receptionist when you were admitted? Yes  No
COMMENTS: 
Did you find the atmosphere comfortable and pleasing? Yes  No
COMMENTS: 
Did you feel you were made to wait too long at any time?  Yes  No     If so, how long? 
COMMENTS: 
Did you have anesthesia? Yes  No
If so, did the anesthesiologist explain your anesthesia in a manner you could understand?
 Yes  No
COMMENTS: 
Were the nurses responsive to your medical and personal needs? Yes  No
COMMENTS: 
Were your discharge and follow-up instructions reviewed with you before leaving the Center? Yes  No
COMMENTS: 
Is there anything you feel we could have done to make your stay with us more comfortable?
Any suggestions to improve our service at our surgery center?
Please rate our performance and select the number that best describes your experience.
  On a scale of 1 (very poor) to 5 (very good)
1. Instructions nurses gave about caring for yourself at home 1      2      3      4      5
2. Degree to which your pain was controlled 1      2      3      4      5
3. Response to concerns/complaints made during your visit 1      2      3      4      5
4. Overall rating of care received during your visit 1      2      3      4      5
5. Likelihood of your recommending our facility to others 1      2      3      4      5
Do you wish to be contacted to discuss any issues? Yes  No     Daytime Telephone # 
 
 
NOTE: Email Address must be valid for Submit Survey to process.