Post-Operative Questionnaire Form
Overall satisfaction of service
Rows
Yes
No
N/A
Was the wait time reasonable for your surgery?
1
2
3
Were the forms that you signed explained to you?
4
5
6
Did you feel you were cared for efficiently and competently?
7
8
9
Was the time spent with the doctor sufficient?
10
11
12
Were all of your questions answered prior to surgery?
13
14
15
Were signs and symptoms of possible problems that may occur at home explained to you?
16
17
18
If problems occurred at home, did you know whom to call?
19
20
21
Did you understand how to take care of yourself at home?
22
23
24
If you had take-home prescriptions, were they explained to you?
25
26
27
Was your privacy provided for and respected?
28
29
30
Did you feel you were treated with respect and courtesy at all times?
31
32
33
Did you feel safe during and after your surgery?
34
35
36
If your answer was "NO" to any of the above, please comment below:
Name
First Name
Last Name
Submit
Should be Empty: