Patient Forms

Patient Satisfaction Survey

Please complete the entire survey by answering all questions to the best of your ability. If a question does not apply to you, leave the question blank or click on the "N/A" button.

Your Comments Are Appreciated

Name (Optional)
Date of Service
Physician's Name
What type of surgery did you have?
Did you receive pre-operative instructions?
Did you talk to the anesthesiologist prior to your surgery?
From the time you arrived at the Surgery Center, approximately how long did you wait before you were taken back to the operating room?
Was the staff courteous and attentive at all times?
Did you at any time during your stay feel hurried?
Was your personal privacy maintained?
Did you receive adequate instructions before going home?
How would you rate your anesthesia experience?
How would you rate your overall surgical experience?
Would you choose Audubon Surgery Center again for future surgery?
Additional comments or suggestions to improve our efficiency and quality of care: