About
Mission
Founders
Services
Resources
Our Providers
Bruce Demko
Camille Santarpio
Charlie Crane
Jon Fisher
Kristin Algoe
Mark Savarise
Mike DiBenedetto
Nathan Kanning
Stuart Gall
Will Magee
Our Reputation
Patient Info
About Your Procedure
Colonoscopy
Forms
Pain Free Surgery
About Anesthesia
Questions
Directions
Contact
Instructions
Please rate your recent outpatient surgery experience at Pend Oreille Surgery Center. Select the answer that best describes your experience. If a question does not apply to you, please skip to the next question.
Background Questions
Date of Procedure (mm/dd/yyyy)
Patients Sex
Male
Female
Patients Age
Physician
Was this your first visit to our Ambulatory Surgery Center?
Yes
No
Patients Name (optional)
Telephone Number (optional)
Would you like us to contact you about your experience?
Yes
No
Registration
Professional and courteous service of registration?
Very poor
Poor
Good
Very good
Satisfactory answers to financial and insurance questions?
Very poor
Poor
Good
Very good
Speed and efficiency of registration?
Very poor
Poor
Good
Very good
Facility
Comfort of registration?
Very poor
Poor
Good
Very good
Comfort of your waiting area in the Center?
Very poor
Poor
Good
Very good
Attractiveness of the Center?
Very poor
Poor
Good
Very good
Cleanliness of the Center?
Very poor
Poor
Good
Very good
Nursing
Waiting time before your surgery or procedure began?
Very poor
Poor
Good
Very good
Explanation physician gave you about surgery/procedure?
Very poor
Poor
Good
Very good
Professional and courteous service of the nurses?
Very poor
Poor
Good
Very good
Skill of the nurse starting IV?
Very poor
Poor
Good
Very good
Nurse explaining procedures?
Very poor
Poor
Good
Very good
Nurses concern for your comfort?
Very poor
Poor
Good
Very good
Nurses courtesy towards family who accompanied you?
Very poor
Poor
Good
Very good
Instructions nurses gave about caring for yourself at home?
Very poor
Poor
Good
Very good
Personal Issues
Information provided about delays? (if delays experienced)
Very poor
Poor
Good
Very good
Our concern for your privacy?
Very poor
Poor
Good
Very good
Degree to which your pain was controlled?
Very poor
Poor
Good
Very good
Response to concerns/complaints made during your visit?
Very poor
Poor
Good
Very good
Overall Assessment
Overall rating of care received during your visit?
Very poor
Poor
Good
Very good
Degree to which staff worked together to care for you?
Very poor
Poor
Good
Very good
Likelihood of your recommending our Surgery Center?
Very poor
Poor
Good
Very good
Comments
Please describe good or bad experiences
Print the Patient Satisfaction Survey here