Post-Procedure Survey

Date

YYYY

How would you rate the instructions APTIVA HEALTH (not the surgery center) provided you BEFORE your procedure or operation?

Scale of 1 to 5 with 1 being the lowest and 5 being the highest.

How would you rate instructions APTIVA HEALTH (not the surgery center) provided you AFTER your procedure or surgery?

Scale of 1 to 5 with 1 being the lowest and 5 being the highest.

How would you rate scheduling that occurred for your procedure or operation?

Scale of 1 to 5 with 1 being the lowest and 5 being the highest.

How would you rate the surgeon or physician providing your procedure or operation?

Scale of 1 to 5 with 1 being the lowest and 5 being the highest.

Would you be willing to provide us a review or testimonial?

Yes

If so, what would you provide?

Photo

Video

Quote

Do you have any additional feedback or comments you would like to provide?

Name

First Name

Last Name