Thank you for choosing Brighton Surgery Center!

Before Your Procedure

Please rate the efficiency of your pre-procedure telephone inteview prior to your visit to Brighton Surgery Center*

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Were you processed from the waiting area to the preop in a timely fasion?*

Yes No

Please rate the pre-procedure instructions you received from your physician.*

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The Procedure

Was this procedure prerformed for:*

Yourself Child Other

What type of procedure did you have?*

Laser Gastroenterology Pain Treatment Surgery Podiatry Orthopedics Other

Other Procedure

If you selected Other, please specify here

After Your Procedure

Were your post-op insructions clear and thoroughly explained?*

Yes No

If you experienced pain after your procedure, was it brought to a tolerable level before you were discharged?*

Yes No

Our Staff

Please rate the personal interest shown to you by the Brighton Surgery Center personnel.*

Excellent Good Fair Poor NA

Please rate the anesthesia services provided, if applicable*

Excellent Good Fair Poor NA

Were all your billing questions answered to your satisfaction?*

Yes No NA

Overall Impression

Please rate the comfort of the facility.*

Excellent Good Fair Poor NA

Would you use Brighton Surgery Center again?*

Yes No

How would you rate your overall experience at Brighton Surgery Center?*

Excellent Good Fair Poor NA

Would you recommend Brighton Surgery Center to family or friends?*

Yes No

Comments and Suggestions

Date of Procedure

Name

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