Questionnaire

Patient Satisfaction Questionnaire

We thank you for choosing The Surgery Center of Carmel, LLC for your healthcare needs, and value your input greatly as to the services we provide. Would you please take a few moments to answer some questions for us?

1. Please rate your satisfaction with the cleanliness of our facility.

2. Please rate your satisfaction regarding the length of time you waited in the reception area for your procedure.

3. How would you rate the personal manner (courtesy, respect, friendliness, sensitivity) of the physician who performed your procedure?

4. How would you rate the personal manner (courtesy, respect, friendliness, sensitivity) of the nurses and other support staff who took care of you?

5. How adequately did we explain what was done for you and were all your questions answered?

6. Please rate your overall satisfaction with your visit to our center.

7. How likely would you be to have a procedure done again at our center?

Any comments and/or suggestions are welcome:

If you would like to have a response to your comments/suggestions please leave your:
Name:
Phone Number:
Email:
Address:

We thank you for taking time to complete this questionnaire for us. Your satisfaction is our most important goal!