handsurg.com :: Hand Surgery Specialists, Inc.

Thank you for choosing Hand Surgery Center for your procedure. We hope your experience was a positive one and that you are well on your way to recovery.

Your comments and suggestions are very important to us. Please assist us in continuing to provide the best care possible by completing this short survey and mailing it back to us in the postage paid envelope. Thank you for helping us to improve the services we provide to our patients and their families. Please fill in the square that best describes the quality of your experience at this facility.

1. Please rate each of the following statements using a 1 to 5 scale, 1 being "poor quality" and 5 being "excellent quality".
2. Receptionist and registration process:
3. 1 2 3 4 5 N/A
4. Pre-operative telephone call or visit:
5. 1 2 3 4 5 N/A
6. Nursing care's responsiveness to your needs prior to and after surgery:
7. 1 2 3 4 5 N/A
8. Interaction with the anesthesia staff:
9. 1 2 3 4 5 N/A
10. Care provided by the surgery staff:
11. 1 2 3 4 5 N/A
12. Care provided by the Recovery Room staff:
13. 1 2 3 4 5 N/A
14. Protection of your privacy:
15. 1 2 3 4 5 N/A
16. Cleanliness and appearance of the Center:
17. 1 2 3 4 5 N/A
18. Overal impression of the care provided during your visit:
19. 1 2 3 4 5 N/A
20. Overall Center experience:
21. 1 2 3 4 5 N/A
22. Please indicate YES or NO to the following questions.
23. Would you recommend the Center to family members or friends?
24. YES NO
25. Did you receive discharge instructions?
26. YES NO
27. Were your questions answered prior to your discharge?
28. YES NO

Additional Information

1. Date of Service(required)
2. Physician
3. Please inform us of additional comments that would help us to provide improved care:

 

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