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Exit Survey
 
 
Our goal is to provide you and your family members with the highest quality, safest, state of the art anesthesia and recovery services. As part of this continuous effort we need your feedback, please take a quick moment to fill out the questionnaire below,
Thank you.
 
 
 
Month:
   
Location:
   
My Surgeon was Dr.
   
 
 
 
This Survey is being filled out for
 
Myself
 
My Spouse
 
My Child
 
Other
 
 
 
 
Perianesthesia Nurse
   
 
 
Excellent Average Unsatisfactory
Professionalism/Courteousness
response to my concerns
 
 
 
Anesthesiologist Dr.
   
 
 
Excellent Average Unsatisfactory
Professionalism/Courteousness
Response to my concerns
Explained anesthesia to my satisfaction
 
 
Post-Procedure Care:
Excellent Average Unsatisfactory
My Immediate post-procedure concerns (such as pain & nausea) were addressed and treated effectively
Discharge instructions were easy to understand
 
 
How would you rate your office-based anesthesia experience in terms of:
Excellent Average Unsatisfactory
Convenience/Comfort
Privacy
Overall Experince
 
 
 
Additional Comments: