Rockford Ambulatory Surgery Center Patient Survey

Patient Survey

At RASC, we value your feedback! Please take a moment to fill out our brief questionnaire so that we may continue to improve our services. All submissions are strictly confidential. Thank you!

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Patient SurveyYesNo
1. Was the receptionist pleasant and helpful upon your arrival for your registration?
2. Were you told when you should last eat and drink before your procedure?
3. Did your pre-operative phone interview provide you with reasonable expectations for your visit?
4. Were your written discharge instructions clear?
5. Were your surroundings and environmnet clean, comfortable, and restful for you?
6. Do you feel positive enough about our service to refer family or friends for care?
7. Do you feel that Rockford Ambulatory Surgery Center provided your care safely in accordance with current State of Illinois Covid-19 guidelines?

If you have further comments on the above questions or would like to offer suggestions for improvement, please add here

Thank you
The Rockford Ambulatory Surgery Center Staff