SURVEY Please rate our performance by checking the response that best describes your evaluation. Feel free to add comments. Upon completion, please click the submit button at the bottom of the form. Thank you for your input and feedback. Admissions / Registration Department 1. Professional and courteous service of office staff GreatGoodFairPoor 2. Speed and efficiency of registration GreatGoodFairPoor 3. Satisfactory answers to financial and insurance questions GreatGoodFairPoor Nursing Department 4. Professional and courteous service of nurses GreatGoodFairPoor 5. Nurses introducing themselves and keeping you informed GreatGoodFairPoor 6. Nurses explaining procedures GreatGoodFairPoor 7. Satisfactory answers to questions GreatGoodFairPoor 8. Written instructions for your home care GreatGoodFairPoor Overall Rating 9. Staff giving you the privacy you needed GreatGoodFairPoor 10. Cleanliness and comfort of the surgery center GreatGoodFairPoor 11. Likelihood that you would return or recommend EJASC to others GreatGoodFairPoor 12. Overall rating of your experience at EJASC GreatGoodFairPoor Additional Information Additional Comments Your Name Your Email Address
