Warning: mysql_query(): No such file or directory in /home/bscit/bendsurgery.com/wp-content/themes/bendsurgery/header.php on line 115

Warning: mysql_query(): A link to the server could not be established in /home/bscit/bendsurgery.com/wp-content/themes/bendsurgery/header.php on line 115

Warning: mysql_fetch_array() expects parameter 1 to be resource, boolean given in /home/bscit/bendsurgery.com/wp-content/themes/bendsurgery/header.php on line 122


 

Patient Satisfaction Questionnarie

Please use the print friendly button to print the form and complete. Mail to Bend Surgery Center at PO BOX 6329, Bend Oregon 97708-6329. Thank you for completing and returning our questionnaire. Your opinion is valuable in helping us maintain a high quality of patient care.




    Excellent   Fair   Poor  

1. Please rate the quality of information you received from the Surgery Center regarding preoperative information.

  5 4 3 2 1 0

2. Please rate the quality of information and education you received from:

             
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0

3. Please rate the quality of care (medical/ nursing) you received from:

             
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0
  5 4 3 2 1 0

4. Overall, how well did the staff protect your dignity and privacy, and ensure your comfort?

  5 4 3 2 1 0

5. Please rate the cleanliness and appearance of the Surgery Center.

  5 4 3 2 1 0

6. What did you like best about your experience at the Surgery Center?

7. What did you like least about your experience at the Surgery Center?

8. Were any Surgery/procedure delays adequately explained?

  Yes     No  

9. Do you have any additional comments or suggestions? We encourage you to share your thoughts on how we might improve our services, or if there is someone's care that stood out who you would like to recognize - we would appreciate hearing from you. (Thank you for your additional comments.)

10. Overall, I was satisfied with my care and I would recommend Bend Surgery Center to a family member.

  5 4 3 2 1 0