Patient Survey

Dear Patient, Thank you for choosing Valley Surgical Suites for your procedure. Providing quality care to our patients is of utmost importance to us. To accomplish this, we would like your input. Would you kindly take a moment to complete this survey?

Would you recommend Valley Surgical Suites to your friends and family?(Required)

Did you receive a satisfactory explanation of your financial responsibility?(Required)

Do you feel your confidentiality was maintained at the front desk during admission?

Were you informed of delays if applicable?(Required)

Do you feel that you received clear and complete explantation of your procedure by the ANESTHESIOLOGIST and SURGEON?(Required)

Do you feel that you received clear and complete discharge instructions and signs and symptoms to watch for?(Required)

Was the nursing staff responsive and address pain concerns prior to discharge?(Required)

Did the staff review your medications and allergies prior to your procedure?(Required)

Were you introduced to your procedural team members upon entry to the OR or procedure room?(Required)

We welcome your comments:

Patient Name (optional)

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Email(Required)

Date of Service

Would you like to leave a quote or short testimonial for our website?

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