Patient Satisfaction Survey

We thank you for giving us the opportunity to care for you. We hope your experience was a positive one and that you are well on your way to recovery.

It is our mission to provide the highest quality of surgical services, considerate of the specific needs of our patients. Your comments and suggestions are very important to us. Please assist us in continuing to provide the best care possible by completing this short survey. Please check the box which best describes the quality of your experience at this facility.

  • Scale Definition:
  • 1-Poor
  • 2-Below Average
  • 3-Average
  • 4-Good
  • 5-Excellent
  • N/A-Not Applicable
1. Pre-admission testing phone call or visit
2. Reception and registration process
3. Care provided by the nursing staff in the pre-operative area
4. Interaction with the anesthesia staff
5. Care provided by the staff in the operating room
6. Care provided by the recovery and discharge nursing staff
7. Protection of your privacy
8. Your sense of safety and security while at the surgery center
9. Cleanliness and appearance of the surgery center
10. Your overall confidence in the care provided to you
Please check the box to indicate YES or NO to the following questions
11. Did you receive discharge instructions?
12. Were the instructions clear?
13. Would you recommend the surgery center to family members or friends?

To mail in this form instead of submitting it via email, please click here to print off and fill out a PDF version. When complete, please send it to:

Capital Region Ambulatory Surgery Center
1367 Washington Avenue, Suite 401
Albany, NY 12206

Thank you for helping us to improve the services we provide to our patients and their families.