This form is made available for you to give feedback on your experience with Acadiana Surgery Center, Inc. This form is completely anonymous. Please help us serve you better by submitting your comments.

PLEASE CHECK OFF YOUR ANSWERS TO THE FOLLOWING QUESTIONS:

1. My procedure was explained to me.
Always Often Not applicable Rarely Never

2. The center was clean and comfortable.
Always Often Not applicable Rarely Never

3. I was given clear discharge instructions verbally and in writing.

Always Often Not applicable Rarely Never

4. I received adequate information about financial agreements.

Always Often Not applicable Rarely Never

5. The waiting time for my procedure was appropriate.
Always Often Not applicable Rarely Never

6. The staff was responsive to my requests.
Always Often Not applicable Rarely Never

7. The staff was courteous and professional.
Always Often Not applicable Rarely Never

8. I had no pain related to my procedure.
Always Often Not applicable Rarely Never

9. The staff managed my pain appropriately.
Always Often Not applicable Rarely Never

Choose the most important item:           Choose an Item... Quality of medical treatment received from Physician Waiting time Cleanliness of facility Courteous nursing staff Courteous office staff
Choose the item second in importance: Choose an item... Quality of medical treatment received from physician Waiting time Cleanliness of facility Courteous nursing staff Courteous office staff

I would improve the care of patients and/or the management of pain at ASC, Inc. by:
Insert your comments here.

What do you feel is needed in Iberia Parish to improve health care?
Insert your comments here: