Patient Post-Surgical Satisfaction Survey

1. Your Contact Information (optional)
2. Name
3. Telephone
4. Consult Date
5. Today’s Date
6. OFFICE STAFF PROCEDURES
7. In your initial contact by phone, was our staff courteous and helpful? Yes No
8. During your visit to our office, was our staff courteous and helpful? Yes No
9. Did the waiting time seem reasonable to you? Yes No
10. THE CONSULTATION PROCESS
11. What do you think about the pre-operative package and post-operative instructions?
12. Was your consultation educational and helpful in understanding the surgery to be done? Yes No
13. Was your consultation educational and helpful in understanding the potential risks and complications? Yes No
14. Were all of your questions answered? Yes No
15. Was accreditation of the surgeon important to you? Yes No
16. Was accreditation of the facility important to you? Yes No
17. What do you think of our brochure and letters?
18. Did you consider another plastic surgery office? Yes No
19. If Yes, Why did you choose our office instead of another?
20. If no, why did you only consider our office?
21. PATIENT SATISFACTION
22. In your initial visit to our office was our staff informative, caring and professional? Yes No
23. Were your financial arrangements made in a professional and non-embarrassing manner? Yes No
24. After your surgery was scheduled, did the amount of contact initiated by our staff meet your pre-operative needs? Yes No
25. Do you feel the staff was easily accessible if you had a question or concern? Yes No
26. What do you think about the pre-operative package and post-op instructions?
27. Is there anything the staff could have done to improve your experience?
28. PHYSICIAN AND SURGERY
29. A. Was your surgeon's treatment...
30. -knowledgeable? Yes No
31. -caring? Yes No
32. -thorough? Yes No
33. -professional? Yes No
34. -patient? Yes No
35. Did your pre and post-operative care meet your needs?
36. Is there anything your surgeon could have done to improve your experience?
37. How do you feel about your surgical result?
38. FOLLOW UP
39. If there were a need for you to have plastic surgery again, would you return to our office?
40. Do you recommend our office to your friends or relatives considering plastic surgery?
41. APPEARANCE / CLEANLINESS / SAFETY OF THE OFFICE
42. Waiting time at the office Excellent Best Average Poor Unacceptable
43. Reception/front desk personnel Excellent Best Average Poor Unacceptable
44. Our Medical Assistants Excellent Best Average Poor Unacceptable
45. Anesthesia Physician Excellent Best Average Poor Unacceptable
46. Anesthesia Nursing Excellent Best Average Poor Unacceptable
47. The answers to your questions-information, teaching, instructions Excellent Best Average Poor Unacceptable
48. Your companion's experience Excellent Best Average Poor Unacceptable
49. Your overall experience Excellent Best Average Poor Unacceptable
50. If pain was an issue, was it addressed and controlled?
51. Did the procedure provide you with the relief of your original symptoms?
52. Did the treatment and services we provided meet your needs and expectations?
53. If necessary would you choose to have surgery here again? Yes No
54. Would you refer your family and/or friends to Midwest Plastic Surgery Specialists? Yes no
55. Do you have any suggestions or comments on how we could improve safety and comfort in our office or our service in the future?
56. Thank you for your cooperation.

 

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Call our Algonquin, Illinois plastic surgery office at 847-458-8808 to schedule your personal consultation with board certified plastic surgeon Dr. Thors.