PATIENT CARE SURVEY
We are happy that you were referred to Advanced Endoscopy Center. We hope that your visit was a pleasant one. To assist in our efforts to improve our services, we would appreciate your response to this questionnaire. Your answers are completely confidential. Please complete this form below or you can download the form and drop it in the mail at your convenience. Thank you.
>>Click here to download form.
| 1. Patient Registration Process? |
| 2. Were your questions answered in a courteous and thorough fashion? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 3. Was the center's staff attentive to your needs? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 4. Do you feel you were treated with respect, consideration and dignity? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 5. Were your discharge instructions adequately explained to you? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 6. At any time were you kept waiting for an extended period of time? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 7. If you were kept waiting for any time, did the staff keep you informed as to the reason for the delay? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 8. Was your escort treated as a guest and made comfortable while waiting? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 9. How would you describe your overall experience at our facility? |
| 1 (Poor) 2 3 4 5 (Excellent) |
| 10. Was there any one individual or aspect of your experience that made it easier or more comfortable for you? |
| Comments or suggestions for improvements: |
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