Patient Satisfaction Survey

We Value Your Feedback

We at Surgicenter of Kansas City care what you think. It is important to us to have your feedback about your experience at Surgicenter of Kansas City so that we know areas in which we've done well and those which need improvement. Your input helps us make our services better for all of our patients.

Please fill out the Patient Satisfaction Survey that will be given to you when you leave the Surgicenter of Kansas City after your procedure. If you prefer, you may fill out our online version of the survey below.

* indicates a required field Patient Satisfaction Survey Form 1. * Name:
2. * Email
3. * Date of Surgery
4. * Physician's Name:
Preparing for Surgery 5. Please rate the manner in which your pre-op instructions were given (were they easily understood):
6. Please rate how well you were informed your co-pay or any other financial arrangements:
On The Day Of Your Surgery 7. Please rate how well the anesthesiologist explained your anesthesia (how thoroughly and in a manner that you could easily understand):
8. Please rate how well the nurses were responsive to your medical and personal needs:
9. Please rate the atmosphere of the Surgicenter (how comfortable and pleasing):
10. Please rate how clearly your discharge and follow-up instructions were explained to you:
After Surgery Did you experience any unexpected problems after your surgery? 11. Discharge from incision
12. Bleeding
13. Muscle Aches
14. Fever over 100
15. Sore throat or hoarseness
16. Other Did you have any of the following problems at home: 17. Nausea or vomiting 18. If so, how long?
19. Excessive pain not controlled by medications 20. If so, how long?
21. Did the surgeon visit with you or your family after surgery?
22. After you left the Surgicenter, were you admitted to a hospital or treated in an emergency room for a complication of your surgery?
23. If you experienced any of the above did you contact your physician?
24. Is there anything we should add to your home care instructions that you feel would be helpful to patients?
General
25. Please rate our staff's courtesy and efficiency:
26. Please rate our staff's competency and professionalism: 27. Did you feel you were made to wait too long at any time? Yes No
28. If so, when? 29. If you should require outpatient surgery in the future, would you choose to return to the Surgicenter of Kansas City? Yes No 30. Please explain:
31. Please provide us with any suggestions for ways to make your next stay more comfortable or improve the Surgicenter services:

If you have any questions about the Patient Satisfaction Survey or any aspect of Surgicenter of Kansas City, please contact us today to speak with a helpful member of our friendly staff.