For more information call: 480.725.9777
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Dr Danton Dungy
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Patient Satisfaction Survey
Patient Satisfaction Survey
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2015-09-14T06:07:45+00:00
Patient Satisfaction Survey
It was our pleasure to serve you! Thinking about you or your family members visit, how would you rate our facility on:
1. Information and instructions given to you before your procedure
Excellent
Very Good
Good
Fair
Poor
2. Registration staff explanations about billing and insurance information.
Excellent
Very Good
Good
Fair
Poor
3. Information given to you regarding the potential risks/complications of the type of anesthesia you received.
Excellent
Very Good
Good
Fair
Poor
4. Courtesy and professionalism of nursing staff toward you and your family member/caregiver.
Excellent
Very Good
Good
Fair
Poor
5. Protection of confidentiality and personal privacy.
Excellent
Very Good
Good
Fair
Poor
6. Degree to which your pain was controlled while at our center.
Excellent
Very Good
Good
Fair
Poor
7. Instructions given to you upon discharge.
Excellent
Very Good
Good
Fair
Poor
8. Cleanliness and comfort of the facility.
Excellent
Very Good
Good
Fair
Poor
9. Response to concerns/complaints, if any, during your visit.
Excellent
Very Good
Good
Fair
Poor
10. Your overall experience and the care you received at our facility.
Excellent
Very Good
Good
Fair
Poor
11. Did you experience any unexpected problems after your procedure?
Yes
No
If yes, please explain:
12. What did you like most about the facility?
13. What did you like least about the facility?
14. Would you recommend this facility to your family and friends?
Definitely Yes
Probably Not
Probably Yes
Definitely Not
15. Please list any general comments, suggestions, or employee who provided exceptional service.
Type of procedure:
Surgical
Pain Management
Other (please provide the details in the space provided:
Date of Procedure:
Name (optional):
Doctors name (optional):
If you wish to reach the Facility Administrator regarding any concerns you may have, please call 480-725-9777
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