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Surgery-Satisfaction Survey

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American Surgery Center - Patient Survey
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Thank you for choosing the American Surgery Center for your surgical care. We are always looking for ways to improve and provide an outstanding patient care experience. Your comments are an important part of that process.

If you would like to address a complaint about a previous visit, or if you have a concern related to treatment, services or patient safety, you may speak directly to our Practice Administrator, Melizza Dimat. You do not need to provide your name on this survey if you wish to remain anonymous.

Kemal Erkan, Chairman

*Please circle the number that reflects your satisfaction with your recent visit to the center with:
Blank=N/A; 1=Very Dissatisfied and 5=Extremely Satisfied.

..
Gracias por elegir American Surgery Center para su atención quirúrgica ti. Nosotros estamos buscando formas de mejorar y proporcionarle a usted una experiencia excepcional. Sus comentarios son parte importante de este proceso.

Si tiene alguna queja sobre una visita, o tiene preguntas acerca de un tratamiento, servicio, o seguridad del paciente, puede hablar directamente con la administradora de nuestra clinica, Melizza Dimat. Si a usted le gustaria permanecer en el anonimato, usted no esta obligado a compartir su nombre en esta encuesta.

Kemal Erkan, Presidente

*Por favor elige el número que refleja su satisfacción con su visita médica reciente con:
Blanco=no aplica; 1= Muy Insatisfecho e 5 = extremadamente satisfecho

Patient Information
Last Name, First Name
(Apellido, Nombre)
 *
Facility
(Clínica)
American Surgery Center
Provider Name
(Nombre de proveedor)
 *
Date of Last Visit
(Fecha de última visita)

STAFF
The courtesy and friendliness of the reception area staff.
The courtesy and professionalism of the nursing staff.
The courtesy and helpfulness of the billing staff.
THE FACILITY
The appearance, comfort and cleanliness of the facility.
The privacy of the environment.
Your satisfaction with the wait times. (If unsatisfied, please explain below.)
SURGICAL ENVIRONMENT
Did the Anesthesiologist answer all of your questions?
If you had local anesthesia or sedation, were you comfortable during the procedure?
Was the staff attentive to your needs during your recovery?
Were your needs met regarding any pain you experienced?
Were you satisfied with the instructions you were given for your care following surgery?
OVERALL SATISFACTION
Would you recommend this facility to a family member or friend?  *
Do you have any suggestions or comments to improve the level of care we provide?
How did you find out about our survey?
EL PERSONAL
La cortesía y la amabilidad del personal en el área de recepción
La cortesía y profesionalismo de las enfermeras
La cortesía y amabilidad del personal de facturación
LA CLÍNICA
La apariencia, comodidad, y limpieza de la clínica
La privacidad del ambiente
Su satisfacción con el tiempo de espera (Si no estuvo satisfecho, por favor explique abajo)
AREA QUIRURGICA
¿Respondio el Anestesiologo todas sus preguntas?
Si a usted se le aplico anestesia local o sedacion, ¿Se sintio comodo durante el proceso?
¿Estuvo el personal atento a sus necesidades durante su recuperacion?
¿Fueron sus necesidades satifechas con respecto a cualquier dolor experimentado?
¿Estuvo usted satisfecho con las instrucciones recibidas para su cuidado despues la cirugia?
SATISFACCIÓN GENERAL
¿Recomendaría esta clínica a un miembro de su familia o un(a) amigo(a)?
¿Tiene algunas recomendaciones o comentarios para mejorar el servicio que usted recibió?
¿Cómo escucho de esta encuesta?
UM ONLY
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