ASC Patient Survey

We greatly value your feedback.

E-mail Address: *

Your Name:

Your Address:

Your Phone No.

Please rate the services you received by responding to each question below.

The date of your surgery or procedure? *

Was this your first visit to the Surgery Center as a patient? *

 Yes
 No

The name of the doctor in charge of your care? *

Surgical procedure was discussed to my satisfaction prior to the event: *

 Excellent
 Good
 Fair
 Poor
 N/A

The phone call to prepare for surgery was helpful: *

 Excellent
 Good
 Fair
 Poor
 N/A

The Surgery Center was comfortable and organized: *

 Excellent
 Good
 Fair
 Poor
 N/A

The staff was available to answer questions and to explain procedures: *

 Excellent
 Good
 Fair
 Poor
 N/A

Post-surgery instruction were explained clearly: *

 Excellent
 Good
 Fair
 Poor
 N/A

Prescriptions were given and explained clearly: *

 Excellent
 Good
 Fair
 Poor
 N/A

The Surgery Center was convenient: *

 Excellent
 Good
 Fair
 Poor
 N/A

The Surgery Center staff was courteous and efficient: *

 Excellent
 Good
 Fair
 Poor
 N/A

Billing and insurance questions were answered clearly: *

 Excellent
 Good
 Fair
 Poor
 N/A

Helpfulness of the phone call to your home after surgery: *

 Excellent
 Good
 Fair
 Poor
 N/A

Anesthesiologist's explanation: *

 Excellent
 Good
 Fair
 Poor
 N/A

Staff concern for your privacy: *

 Excellent
 Good
 Fair
 Poor
 N/A

What did you find most informative about the Surgery Center? *

What did you like most about the Surgery Center? *

What did you learn about the Surgery Center? *

Were there any problems you did not anticipate? *

How might we improve? *

Would you tell others about the Surgery Center? *

 Yes
 No

Which location would you prefer for Surgery? *

 Hospital
 Surgery Center

Reasons for your preference? *

How did you learn of the Surgery Center? *

Verification Code:

Enter Verification Code: *

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Spokane Valley ENT

1424 N. McDonald Rd., Suite 101
Spokane Valley, WA 99216

Click for directions »

509.928.7272