Select Page
There was a problem with your submission. Please review the fields below.

Outpatient Patient Survey

Dear Patient,

I am pleased that you chose our facility for your outpatient procedure. I hope that your stay with us was as comfortable as possible. Our goal is to provide quality service to you and your family members. This is why I'm inviting your response to this questionnaire.

With your help, the staff of the Outpatient Plastic Surgery Center can evaluate how effectively we are meeting the challenge of providing quality health care.

The responses will be thoroughly reviewed and kept strictly confidential.

Thank you for your time and comments.
Warmest Regards,
Nancy Borroto, RN
Nursing Administrator

  • Date Format: MM slash DD slash YYYY
  • Please give us your confidential opinion on the following items:

  • Please click.....A -EXCELLENT, B - GOOD, C - POOR
  • 2. How would you rate the Waiting Room?
  • 3. How would you rate the Front Desk?
  • 4. How would you rate your nurses/surgical technicians?
  • 5. How would you rate your Physician?