Post Operative Survey

We have tried to make your Same Day Surgery experience as comfortable and convenient as possible. We are interested in your assessment of our surgical services, personnel, and facilities. To help us evaluate our service, please take a moment to complete this questionnaire and return it to us as soon as possible. Your participation is appreciated.


Date of Surgery:       


Type of Surgery:       


1. Do you feel the pre-surgery phone call from the Nurses provided enough information to prepare you for surgery? 

2. Was the patient registration process simple? 

3. Do you feel the Pre-Operative & Post Operative nursing staff maintained your privacy and provided attention to your needs and concerns? 

4. Please rate your overall anesthesia experience.  

5. Did the staff meet your pain control needs during your visit? 

6. Were written instructions given and reviewed prior to discharge with you and your family member/other?

7. Were you treated in a courteous, professional and kind manner? 

8. Were you comfortable with the lighting, temperature and general surroundings?

9. Was your family member or friend comfortable while waiting?   

10.  How would you rate your overall experience?  

Please list any comments or suggestions:




Please click the submit button once.  There may be a slight delay after you click on Submit.  You will be taken to a confirmation page once the form is properly submitted.


5202 Miller Road
Flint MI 48507