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    PATIENT SURVEY

    		  
     
    		 
         
     

    Patient satisfaction is important to our practice and we value your feedback on your experience with us. Thank you for taking the time to complete the survey below.

    Instructions: Click on the circle that best describes your experience.

     

    		  
     
    Name:
     
    Email:
     
    Phone:
     
    Service Date:
     
    Account Number:
     
    1. My Anesthesia Doctor met with me before the procedure to discuss my anesthesia care in a manner that I could easily understand and answered my questions in a courteous way.
    Strongly Disagree
    Agree
    Strongly Agree
     
    2. My Nurse Anesthetist also met me before the procedure to further discuss my anesthesia care in a courteous and respectful manner.
    Strongly Disagree
    Agree
    Strongly Agree
     
    3. My Anesthesia Care Team (Anesthesia Doctor and Nurse Anesthetist) were thorough, careful and friendly.
    Strongly Disagree
    Agree
    Strongly Agree
     
    4. I would recommend care by Midlands Anesthesiology to my family and friends.
    Strongly Disagree
    Agree
    Strongly Agree
     
    Questions or comments:
     
     
    		 
     


    If you have any questions please contact us:

    Midlands Anesthesiology
    Attn: Billing Department
    PO Box 1427
    Columbia, SC 29202

    Phone: 803-765-1838

    MA@patient-billing.com

    		  
     

     

     

     

     

     

     
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