Thank you for visiting ASC Durango for your recent surgery. Your comments about your experience are very important to us. Please take a moment to complete this survey.
Date of Surgery:
Was this your first visit to ASC Durango? Yes No
Name: Age: Sex: Select Male Female
Please select the answer that applies for each statement:
Yes No The pre-surgical phone call was helpful in preparing me for surgery.
Yes No The admission process was prompt.
Concern was shown for my comfort, and my privacy was respected by:
Yes No Nurses in Pre-op area
Yes No Nurses in Surgery
Yes No Nurses in Recovery areas
Yes No Anesthesia Personnel
Yes No Surgeon
Explanations I was given about my procedure were complete and understandable when given by:
Yes No Nurses
The staff were courteous, friendly and concerned about my individual needs:
Yes No The temperature of the facility was comfortable.
Yes No My pain was adequately controlled during and after my procedure.
Yes No Nurses and anesthesia personnel were concerned not to send me home too soon.
Yes No Instructions I was given about caring for myself at home after surgery were understandable and complete.
Yes No Personnel were concerned for family/friends who accompanied me the day of the surgery.
Yes No The waiting area was comfortable for my family/friends.
Yes No I would return to ASC Durango and would recommend it to others.
After you returned home did you experience any complications such as:
Prolonged nausea and vomiting: Yes No
Fever/Infection: Yes No
Unusual bleeding: Yes No
Uncontrolled pain: Yes No
Visit to emergency room: Yes No
Please explain:
Comments
