After Surgery Questionnaire

Thank you for choosing Kissimmee Surgery Center! It was our pleasure to serve you. Your comments are important to us. Please let us know what you think about the services received.

1. Please rate the efficiency of your pre-procedure telephone interview prior to your visit to Kissimmee Surgery Center.
   Excellent    Good    Fair    Poor    NA
                          
   
2. Was this procedure performed for:
   Yourself     Child     Other  
               
   
3. Please rate the comfort of the facility.
   Excellent    Good    Fair    Poor    NA
                    
   
4. Please rate the post-procedure instructions you were given.
   Excellent    Good    Fair    Poor    NA
                     
   
5. Please rate the personal interest shown to you by the Kissimmee Surgery Center personnel.
   Excellent    Good    Fair    Poor    NA
                     
   
6. Please rate the anesthesia services provided, if applicable.
   Excellent    Good    Fair    Poor    NA
                    
   
7. Please rate your overall experience at Kissimmee Surgery Center.
   Excellent    Good    Fair    Poor    NA
                    
   
8. Was the fact that you could return home the same day a factor in your decision to use Kissimmee Surgery Center?
   Yes     No
     
   
9. Was the decision to choose Kissimmee Surgery Center your decision?
   Yes     No
     
   
10. Were your financial matters handled properly?
    Yes     No
     
    
11. Would you recommend Kissimmee Surgery Center to family or friends?
    Yes     No
      
    
12. Would you use Kissimmee Surgery Center again?
    Yes     No
      
    
13. What did you like most about Kissimmee Surgery Center?
    
    
14. What did you like least about Kissimmee Surgery Center?
    
    
15. Please list any general comments, suggestions, or employees who provided exceptional service.
    

Date of Procedure  

Name (Optional) 

We are constantly striving to improve our services. Thank you for your help.

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