patient resources general patient forms preparing for surgery preparing for pain management patient survey specialties contact/location Your feedback allows us the opportunity to improve. Please take the short survey below to share your experience. A patient experience of care survey Thank you for choosing our center for your surgical care and treatment. It was our pleasure to assist and make your ambulatory surgery experience as comfortable and convenient as possible. Our State Certification and Accreditation body requires that we collect and report patient experience surveys. Please take a few minutes of your time and let us know what you like (or don’t like) about our services. Any comments are welcomed and would be appreciated. Thank you for your assistance. Survey Instructions Please answer all the included questions. You will sometimes be asked to skip over some questions in this survey. When this happens we will note what question to answer next, like this: "If No, go to #1" This survey asks about your experience at San Mateo Surgery Center. For this survey, we use the term “procedure” for diagnostic, surgical or other procedures. Date of Procedure MM DD YYYY 1. Before your procedure, did your doctor or anyone from the facility give you all the information you needed about your procedure? Yes, definitely Yes, somewhat No 2. Before your procedure, did your doctor or anyone from the facility give you easy to understand instructions about getting ready for your procedure? Yes, definitely Yes, somewhat No 3. Did the check-in process run smoothly? Yes, definitely Yes, somewhat No 4. Was the facility clean? Yes, definitely Yes, somewhat No 5. Were the clerks and receptionists at the facility as helpful as you thought they should be? Yes, definitely Yes, somewhat No 6. Did the clerks and receptionists at the facility treat you with courtesy and respect? Yes, definitely Yes, somewhat No 7. Did the doctors and nurses treat you with courtesy and respect? Yes, definitely Yes, somewhat No 8. Did the doctors and nurses make sure you were as comfortable as possible? Yes, definitely Yes, somewhat No 9. Did the doctors and nurses explain your procedure in a way that was easy to understand? Yes, definitely Yes, somewhat No 10. Anesthesia is something that would make you feel sleepy or go to sleep during your procedure. Were you given anesthesia? If No, skip to question #13 Yes No 11. Did your doctor or anyone from the facility explain the process of giving anesthesia in a way that was easy to understand? Yes, definitely Yes, somewhat No 12. Did your doctor or anyone from the facility explain the possible side effects of the anesthesia in a way that was easy to understand? Yes, definitely Yes, somewhat No 13. Discharge instructions include things like symptoms you should watch for after your procedure, instructions about medicines, and home care. Before you left the facility, did you get written discharge instructions? Yes No 14. Did your doctor or anyone from the facility prepare you for what to expect during your recovery? Yes, definitely Yes, somewhat No 15. Did your doctor or anyone from the facility give you information about what to do if you had pain as a result of your procedure? Yes, definitely Yes, somewhat No 16. At any time after leaving the facility, did you have pain as a result of your procedure? Yes No 17. Before you left the facility, did your doctor or anyone from the facility give you information about what to do if you had nausea or vomiting? Yes, definitely Yes, somewhat No 18. At any time after leaving the facility, did you have nausea or vomiting as a result of either your procedure or the anesthesia? Yes No 19. Before you left the facility, did your doctor or anyone from the facility give you information about what to do if you had bleeding as a result of your procedure? Yes, definitely Yes, somewhat No 20. At any time after leaving the facility, did you have bleeding as a result of your procedure? Yes No 21. Possible signs of infection include fever, swelling, heat, drainage or redness. Before you left the facility, did your doctor or anyone from the facility give you information about what to do if you had possible signs of infection? Yes, definitely Yes, somewhat No 22. At any time after leaving the facility, did you have any signs of infection? Yes No 23. Using any number from 0 to 10, where 0 is the worst facility possible and 10 is the best facility possible, what number would you use to rate this facility? 24. Would you recommend this facility to your friends and family? Definitely no Probably no Probably yes Definitely yes 25. In general, how would you rate your overall health? Excellent Very good Good Fair Poor 26. In general, how would you rate your overall mental or emotional health? Excellent Very good Good Fair Poor 27. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 79 80 to 84 85 or older 28. Are you male or female? Male Female 29. What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree 30. Are you of Hispanic, Latino, or Spanish origin? If no, skip to question 3 Yes, Hispanic, Latino, or Spanish No, not Hispanic, Latino, or Spanish 31. Which group best describes you? Mexican, Mexican American, Chicano Puerto Rican Cuban Another Hispanic, Latino, or Spanish origin 32. What is your race? White Black or African American American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander 33. How well do you speak English? Very well Well Not well Not at all 34. Do you speak a language other than English at home? If no, skip to question 36 Yes No 35. What is that language? Spanish Other Language 36. Did someone help you complete this survey? If no skip to end. Yes N 37. Did someone help you complete this survey? Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way: Comments Additional comments here No one helped me complete this survey Check Here PATIENT SURVEY CONTACT/LOCATION