125 Lattimore Road - Rochester, NY 14620   Phone: (585) 473-9000   Fax: (585) 473-9018

 

 

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Patient Satisfaction Survey

We are pleased that you and your physician chose the Lattimore Community Surgicenter for your procedure.

By completing this questionnaire, you will be able to assist us in accomplishing our goal of providing the highest quality health care and attention to our patients and their families. Your comments will be reviewed for implementation to further enhance our services.

Your time and assistance is greatly appreciated. Please be assured your response to this questionnaire will be kept confidential.
 

E-mail Address: *

Enter your Physician in the space provided below. (optional/confidential)
Type of surgery: *
Procedure: *
Enter the date of your surgery: *
Rate the following questions from 1 - 5, with a 1 being poor and 5 being excellent.

Did the registration personnel demonstrate courtesy and concern? *
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2
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 4
 5
 N/A
If your procedure was delayed, were you kept informed? *
1
2
 3
 4
 5
 N/A
Was the nursing staff professional and courteous? *
1
2
 3
 4
 5
 N/A
Did you understand your discharge instructions? *
1
2
 3
 4
 5
 N/A
If you had any complications after you returned home, please explain:
What was your biggest concern before your procedure?
How did Lattimore perform in regards to your concern mentioned above?
We welcome all comments positive and negative.
* Required