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

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