Satisfaction Survey Patient's Name Physician's Name:(Required) Date of procedure(Required) MM slash DD slash YYYY if you don't know the exact date, please estimate.Please Indicate your overall impression of your surgical experience at Greenbrae Surgery Center(Required)PoorBelow AverageAverageAbove AverageExcellentWould you recommend Greenbrae Surgery Center to family & friends?(Required)YesNoPreadmission phone calls were clear and helpful(Required)YesNoThe reception staff were friendly and helpful upon arrival(Required)YesNoThe nursing staff were friendly and helpful(Required)YesNoThe instructions from your physician were clearly explained to you prior to your discharge(Required)YesNoThe anesthesiologist answered your questions regarding your anesthesia care(Required)YesNoPrior to my admission date, I was made aware that I needed a responsible party to stay with me for 24 hours(Required)YesNoAt the time of discharge, I was well informed on the care required for the next 24 hours(Required)YesNoThe written information provided (email, print) was easy to understand(Required)YesNoPlease feel free to offer any comments or suggestions:CAPTCHANameThis field is for validation purposes and should be left unchanged.
