Please rate our performance by checking the response that best describes your evaluation. Feel free to add comments. Thank you for your input and feedback. Admitting/Registration Professional and courteous service of office staff: Excellent Good Poor Very Poor Speed and efficiency of registration: Excellent Good Poor Very Poor Satisfactory answers to financial and insurance questions: Excellent Good Poor Very Poor Nursing Professional and courteous service of nurses: Excellent Good Poor Very Poor Nurses introducing themselves and keeping you informed: Excellent Good Poor Very Poor Nurses explaining procedures: Excellent Good Poor Very Poor Satisfactory answers to questions: Excellent Good Poor Very Poor Written instructions for your home care: Excellent Good Poor Very Poor Overall Staff giving you the privacy you needed: Excellent Good Poor Very Poor Cleanliness and comfort of the Surgicenter: Excellent Good Poor Very Poor Likelihood that you would return or recommend the Surgicenter to others: Excellent Good Poor Very Poor OVERALL, rating of your experience at the Surgicenter: Excellent Good Poor Very Poor Additional Comments: Optional Information Name: Address:
