Cardiac Catheterization Experience Survey
Share feedback about your cardiac catheterization experience so the care team can review comfort, communication, and overall satisfaction.
Patient Experience Details
Date of catheterization visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location or department of visit
*
Reason for survey (optional)
Was this your first catheterization experience?
*
First-time
Repeat experience
Care and Comfort Ratings
Care and Comfort Ratings
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Staff communication
1
2
3
4
5
Clarity of instructions
6
7
8
9
10
Wait time
11
12
13
14
15
Comfort during the procedure
16
17
18
19
20
Pain management
21
22
23
24
25
Privacy and respect
26
27
28
29
30
Post-procedure explanations
31
32
33
34
35
Overall satisfaction
*
1
2
3
4
5
How would you rate the wait time?
Too long
1
2
3
4
5
6
7
8
9
Very acceptable
10
1 is Too long, 10 is Very acceptable
How would you rate your pain management during the procedure?
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Follow-up Feedback
Comments or suggestions for the care team
Would you recommend this facility based on your experience?
Yes
No
Not sure
Submit Survey
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