ETASC Patient Satisfaction Survey – East Tennessee Ambulatory Surgery Center

Date of Service

5 = Strongly Agree; 3= Neutral; 1 = Strongly Disagree; Leave blank if Not Applicable.

The Pre-Operative appointment with the nurse provided adequate information to prepare me for surgery.

The patient registration process is simple.

The front office staff was courteous and attentive.

The staff helped to relieve my fears and anxieties in order to make my visit more pleasant.

I was treated in a courteous and professional manner.

Who did you feel was not courteous or professional?

Clear and concise written instructions were given to and reviewed with your caregiver.

I felt I had adequate privacy while in the pre- and post-operative areas of the Center.

I was updated about any delays.

How would you rate your overall experience?

Comments:

Please give us any comments or suggestions of how we can improve our Center.

You are welcome to complete this survey anonymously. If you would like to be contacted, please tell us how we may reach you.

Name:

Phone

Address

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