Market Street
Surgical Center
444 Market Street
Saddle Brook, NJ 07663
Phone (201) 843-9441
Fax (201) 843-9442
“Quality Without Compromise”
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Market Street Surgical Center Patient Satisfaction Survey
Date of Surgery: _________ Male___ Female___ Date of Birth: ____/____/____
Surgery Performed: _____________________ Doctor: __________________________
Was this your first time as a patient at our facility? Yes___ No___
Have you ever had a surgical procedure done at a hospital? Yes ___ No___
Would you say your surgical experience was better in the hospital? Yes___ No___
Front Desk /Appointment Making/ Transportation:
My appointment making/transportation set up was professional and clear
as to the date and time?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
Greeted professionally and kindly in a timely matter when I walked through
the door?
Very Poor___ Poor___ Satisfactory___ Good ___ Excellent___
Paper work and any insurance questions were clearly explained upon check
in?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
Transportation Driver was on time, courteous, and professional?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
Facility Appearance
The lobby/ waiting room/ bathroom(s) were clean and organized.
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
The patient care areas were cleaned, well lit, and organized
Very Poor___ Poor___ Satisfactory___ Good ___ Excellent___
Medical Care
How would you rate the nursing care at our facility?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
How would you rate the anesthesia care at our facility?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
Overall, I would rate the medical care I received at Market Street Surgical
as?
Very Poor___ Poor___ Satisfactory___ Good___ Excellent___
Is there anyone you would like to name that went above and beyond to make you feel comfortable and at ease with your total experience at Market Street Surgical Center? _________________________________________________________________________________
Is there anything that you would like to see changed? If so please describe. _________________________________________________________________________________
Would you recommend this facility to your family/ friends for care? Yes___ No___
Please mail completed form to:
Market Street Surgical Center
444 Market Street
Saddle Brook, NJ 07663
or Fax to (201) 843-9442