Search
  
Surgery
 
Completed the Program? Take Our Survey!

We encourage all participants to complete our easy online survey. Your input will help us make any necessary improvements to the program.

Patient Satisfaction Survey
Prepare for Surgery, Heal Faster Program

We invite all participants of the Prepare for Surgery, Heal Faster Program to share their experience and opinions with us, so that we can help improve the program. Your thoughts are important to us and we appreciate your willingness to take the time to answer these questions.

All responses are confidential unless you indicate otherwise.

Please rate each of the following on a scale of 1-5, where 5 is Very Helpful and 1 is Not At All Helpful. If you did not use part of the program, please select "0".

1. Information Booklet:
5 4 3 2 1 0

2. Relaxation CD, at home:
5 4 3 2 1 0

3. Relaxation CD, used in Operating Room (OR):
5 4 3 2 1 0

4. In-person or Phone Time with the Program Nurse:
5 4 3 2 1 0

5. Healing Statements spoken in Operating Room:
5 4 3 2 1 0

6. Supportive Group and Blanket of Love:
5 4 3 2 1 0

7. In general, how did the entire program help you cope?
5 4 3 2 1 0

8. If you had to choose the one component that was most helpful, which would you choose?

Book, Prepare for Surgery, Heal Faster
Relaxation CD (at home)
Relaxation CD (in the operating room)
In-Person or Phone Time with the Program Nurse
Healing Statements
Supportive Group/Blanket
Cannot Decide/All Helpful

9. Would you like to make any additional comments about any of the items listed above in the program components?


We would like to know the effect the Prepare for Surgery, Heal Faster Program had on you after surgery. Please answer Yes, No or Not Sure for each of the following:

10. Do you feel it helped you sleep better?
Yes No Not Sure

11. Do you feel it helped reduce your anxiety?
Yes No Not Sure

12. Do you feel it helped feel more positive about your surgery?
Yes No Not Sure

13. Do you feel it helped you to reduce your pain?
Yes No Not Sure

14. Do you feel it helped you to heal faster?
Yes No Not Sure

15. Do you think it played a positive part in your recovery?
Yes No Not Sure

16. Would you recommend this program to others?
Yes No Not Sure

17. Would you like to make any additional comments about the program in general?


The following information is optional:

Name:

Date of Workshop (in person or on phone):

Type of Surgery:

Date of Surgery:

Name of Surgeon:

Would you like this information passed on to your surgeon?
Yes No