Breast augmentation review by Wilfredo

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?

The best part was when he told me how much amount of silicone implant can put in my breast, and when he told me he can do my surgery. 

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

Because when I was looking online I was very comfortable watching his videos and I love that he explained everything. 

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

Nothing everything ______ did was perfect and _____. 

How was your experience with the anestheologist?

My experience with the aneetheologist was excellent. 

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?



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

Im very happy with everything and I learning that we don’t need to go to different country to have a surgery because here on USA we have a very good doctor especially doctor Rodriguez. He is the best.

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