Breast augmentation review by Amelia


Thank you for taking the time to complete the following questionaire. Please circle, check, or fill in your responses. Return it in the enclosed self-addressed, stamped envelope.


What procedure(s) did you have performed during your most recent surgery?Breast augmentation
How would you rate your final result(s)

Excellent ........................... Poor

Would you recommend our practise to your friends?

What was the best part about your consult?

He took the time to answer all questions I had never felt rushed 

Why did you select Dr. Rodriguez and our office for your surgery?

Because out of 3 consults I had with other Drs he was the one that I felt the most comfortable with. He had a personal plan just for me to get the best result. 

What else could we have done to help you prepare for your surgery?

Nothing really every thing was great. 

How was your experience with the anestheologist?

Wonderful he was very nice. 

Please indicate your experience in the recovery room:
Duration of recovery room time

Temperature in the recovery room

My pain management in the recovery room

Other, please explain:

 

Would you return to this office if you decide to have additional surgery

 

Which of the following factors influenced you to choose Dr. Rodriguez?

 

He was very knowledgeable and patient with me and every question I had. 


Were your telephone calls to our office handled to your satisfaction?

Additional comment about telephone handling

 

Were you satisfied with the way your surgery was scheduled?

Additional comment about surgery scheduling

 

How well do you agree with the following statements? (If any item does not apply, leave blank)
The amount of time that I had to wait to get a consultation with Dr. Rodriguez was reasonable

I was satisfied with the information and surgical description provided by Dr. Rodriguez

The office staff was attentive to my needs

The OR staff was attentive to my needs

The written materials that I received prior to surgery satisfied my needs.

I was satisfied with the way I was prepared for surgery

I was satisfied with the care that I received the morning of surgery

I was satisfied with my follow-up care

The fees for surgery were reasonable

Additional Comments

Thank you for taking the time to complete this questionare
May we share your confidential comments with prospective patients

Would you like someone to call you regarding any of your responses

Name

Amelia 

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