3801 INTERNATIONAL DRIVE • SUITE 300
SILVER SPRING, MARYLAND 20906
Phone: 301-598-5100 • Fax: 301-598-2894
Please fill in or place a mark in the circle that best describes the quality of your experience at the Surgery Center of Maryland.
Scale Definition: 1 - Poor 2 - Fair 3 - Average 4 - Good 5 - Excellent NA
1 |
2 |
3 |
4 |
5 |
NA |
|
| 1. Reception and registration process | ||||||
| 2. Pre-operative telephone call | ||||||
| 3. Care provided by the nursing staff before your procedure | ||||||
| 4. Interaction with the Anesthesia staff | ||||||
(This does not apply (NA) to patients receiving local anesthesia or sedation for EGD or colonoscopy.) |
||||||
| 5. Care provided by the nursing staff after your procedure | ||||||
| 6. Protection of your privacy | ||||||
| 7. Discharge instructions | ||||||
| 8. Your overall confidence in the care provided to you by all staff | ||||||
| 9. Cleanliness and appearance of the Surgery Center | ||||||
| 10. Would you recommend the center to your family and/or friends? | Yes
|
No
|
||||
| What did you like BEST about your experience at the Surgery Center of Maryland? |
| What did you like LEAST about your experience at the Surgery Center of Maryland? |
| If you scored any questions on the reverse side with a 3 or less, please let us know how we can improve. |
Thank you for helping us to improve the services we provide to our patients and their families.