In Office Procedure Satisfaction Survey

At Virginia Beach Obstetrics and Gynecology, our goal is to make your experience with our practice as pleasant as possible. We value your insight with regard to how well we accomplished that goal during your recent office surgery in our surgical suite.



1. Would you like to be contacted by our practice manager?
YesNo

2. When your surgery was scheduled:
- Were you contacted in a timely manner by the surgery scheduler?
YesNoN/A
- Was the surgery scheduling done in an efficient manner?
YesNo
- Do you feel that you were adequately prepared for the procedure, and understood the risks and benefits and expected outcome of the procedure?
YesNo
- Were all of your questions answered satisfactorily?
YesNo

3. At the time of your surgery, were you greeted promptly and courteously upon arrival?
YesNo
- Did you find the waiting time acceptable?
YesNo

4. Did you find the surgery suite to be acceptable (i.e. comfort, cleanliness, temperature)?
YesNo

5. Were you greeted appropriately by the nursing staff?
YesNo
- Did you find that the nurse or medical assistant prepared you for the procedure appropriately (i.e. directing you to the restroom, exam room, etc., instructing you on gowns, drapes, starting your IV, etc.?
YesNo

6. Did your procedure start on time?
YesNo

7. Were you satisfied with your postoperative care/recovery?
YesNo
- Did you find your postoperative instructions to be adequate?
YesNo
- Did you have any post-op problems or complications (excessive pain, bleeding,
infection, fever)?
YesNo
--If yes, comment:

8. Overall, are you happy with the outcome of your procedure?
YesNo

9. Do you feel that your problem was helped or resolved by this procedure?
YesNo

10. Please rate your pain during the procedure on a scale of 1-10:

11. Please rate your pain 15 minutes to 1 hour after the procedure on a scale of 1-10:

12. Please rate your pain on the 12 hours following your procedure on a scale of 1-10:

13. Please rate your pain on the 24th hour after your procedure on a scale of 1-10:

14. Please rate your overall experience on a scale of 1-10:

15. Would you do this procedure again in-office at the Virginia Beach OB/GYN if surgery were needed?
YesNo

16. Do you have any additional comments, questions or feedback?

17. Do we have permission to reproduce all or a portion of your comments on our website as a patient testimonial?
- If you answer yes, only your first name and last initial will be used. Thank you.
YesNo