Evansville Surgery Center - Take Our Survey

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This form is intended to be used by former patients of the Evansville Surgery Center as an easy way of submitting feedback electronically. Please complete the items below and select submit.

Gateway Campus

Deaconess Campus

	5	4	3	2	1
Likelihood that you would recommend our facility.
The ease of finding the Evansville Surgery Center.
The friendliness of our staff upon your arrival.
How well we kept you / your family informed during your stay.
Our Respect for the privacy of your personal information
How well our nurses prepared you for surgery.
The effectiveness of our staff in addressing your needs.
How well your pain was managed.
The clarity of your discharge instructions.
Your level of confidence in the care provided.

Did anyone go above and beyond to help you during your visit? If so, who and in what way?

What suggestions do you have that could help us improve any aspect of our care?

If Evansville Surgery Center would need to contact you to follow-up on a concern, please provide your information below:

Name:

Phone Number:

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