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Patient Satisfaction Survey

We value your opinion in our efforts to maintain a high quality of patient care provided at the Crystal Run Healthcare Endoscopy Center. Please take a moment to complete the following survey. If a question is N/A, please just skip it. Thank you.

Please rate the following on a 1 to 5 scale with 1 the lowest and 5 the highest rating.

Before Day of Surgery

The quality of information and education you received from CRHC Endoscopy/Newburgh prior to the day of surgery

The CRHC Endoscopy/Newburgh ‘s communication with you regarding your financial responsibilities that were to be paid the day of surgery

Registration

The quality and efficiency of the registration process

You and your family’s experience in the waiting area of the CRHC Endoscopy/Newburgh

Your Physicians

The courtesy, friendliness and care of your physician/surgeon

The anesthesiologist’s courtesy and explanation of information

The ASC Staff

The courtesy, friendliness and care of the CRHC Endoscopy/Newburgh staff, before, during and after the procedure

The clarity of the explanation of your discharge instructions

Overall Experience

The CRHC Endoscopy/Newburgh staff’s efforts to protect your privacy and ensure your comfort

Your overall experience at the CRHC Endoscopy/Newburgh

Would you like to be contacted by the CRHC Endoscopy/Newburgh’s Administrator to discuss any aspect of your visit?

Yes

Only if “yes”, please include a contact name and telephone number.

Name

Phone