Fleming Island Surgery Center

Fleming Island Surgery Center

Thank you for completing this important questionnaire regarding your visit. Your feedback is very important in helping us continue to provide the highest possible level of care and comfort.
Please select the name of the physician you saw at this visit*
Instructions: Please rate your agreement with the following statements based on your recent surgical experience. We welcome your comments as they help us learn about your experience and care.
Prior to My Procedure
The instructions I received prior to procedure were helpful and easy to understand.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
The Clerks and Receptionists were courteous and helpful.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
My waiting time prior to my procedure was reasonable and as expected.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
Nursing Care and Communication
The Nursing Staff was courteous and friendly.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
The Nursing Staff was concerned for my comfort.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
The nursing staff explained things in a way that I could understand.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
Physician Care & Communication
My Physician was courteous and friendly.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
My Physician spent adequate time with me explaining my procedure and answering my questions.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
My Physician explained things in a way that I could understand.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
I will recommend my provider to my family and friends.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
My Recovery in the Facility
The Recovery Staff was courteous and friendly.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Adequate time was allowed for my recovery at the facility.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
Discharge Instructions & Home Follow-up
My discharge instructions were clear and helpful.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
When I was contacted at home, the Clinical Staff was concerned for my progress and comfort.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
Your Experience
My privacy was respected at all times.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
My family/friends were adequately informed throughout my visit.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
The facility was clean.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
I felt safe while at the facility.*

Strongly AgreeAgreeDisagreeStrongly DisagreeNot Applicable
Comments or Suggestions
Your Overall Impressions
Overall, I am very confident in the care I received at your facility.*

Strongly AgreeAgreeDisagreeStrongly Disagree
I will recommend your facility to my friends and family.*

Strongly AgreeAgreeDisagreeStrongly Disagree
What did you like best about our facility?
What did you like least about our facility?
Is there anything we could have done to improve your experience?
About You
Were you the patient?*

YesNo
Patient's Gender?*

MaleFemale
Patient's Age Group?*

Under 1616-2425-3435-4445-5455-6465 and over
If you would like to be contacted to discuss any negative responses you may have provided, please select 'Yes', and provide full contact information below.*

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Your Name

First NameLast Name
Phone Number

Area CodePhone Number
Date of Procedure

MonthDayYear
If you would like your survey responses to remain anonymous to the procedure center, please select "Yes" below.*

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If you have any medical questions or concerns, please contact your Physician's office at 904-398-7205. Thank you for participating in the Jacksonville Center for Endoscopy Patient Satisfaction Survey.
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Fleming Island Surgery Center

About You