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Surgical Coordination Services
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Patient Feedback Form
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Tell us how we did! Your Feedback is Very Important to Us.
Thank you so much for choosing CSTAR International as your surgical coordinator. We love what we do! That's why we value your evaluation so that we can continue to improve and provide excellent service.
Date
*
Country
*
Costa Rica
Colombia
Dominican Republic
Mexico
Thailand
USA
Other
Please select the country you visited for your surgical journey.
If other, please write the name of the country
Name:
*
Email
*
Doctor
*
Recovery Facility
*
Date of Travel
*
(or month if you do not know exact date)
List all procedures you had done:
*
CSTAR SURGICAL COORDINATOR SERVICES REVIEW
Friendliness/courtesy of the coordinator
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Explanations the coordinator gave you about your surgical journey
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Explanations the coordinator gave you about your quote, payment, and cancellation process
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Concern the coordinator showed for your concerns or worries
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
How was the communication and the follow-up care during your surgical journey?
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Amount of time your coordinator spent with you
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Your confidence in your coordinator
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Likelihood of your recommending CSTAR International to others
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Please tell us how was the experience with your CSTAR International coordinator?
*
DOCTOR'S REVIEW
How was your Experience upon arrival at the clinic?
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
The Administrative staff was polite, courteous, and respectful
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Friendliness/courtesy of the Doctor
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Explanations the doctor gave you about your surgery
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Doctor's efforts to include you in decisions about your procedures
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Information the doctor gave you about medications (If any)
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Your confidence in this Doctor
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Skills of assisting staff, for example when taking care of you after sugery
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Likelihood of your recommending this doctor to others
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Please tell us how was your overall experience with your doctor
*
RECOVERY FACILITY, ACCOMMODATION, AND SERVICES REVIEW
How was your Experience upon arrival at the Recovery Facility?
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
The Administrative staff was polite, courteous, and respectful
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Was the room comfortable and clean?
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
The care and attention of the nurses
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Taste and quality of the food
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Common areas were clean, comfortable, and accessible
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Attitude, performance, and punctuality of the driver
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Likelihood of your recommending this Recovery Facility to others
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Please tell us how was your overall experience with the Recovery Facility?
Overall how would you rate the teamwork between your CSTAR surgical coordinator, the doctor, and the recovery facility
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
Overall how whould you rate your entire surgical jorney
*
Select
5- Excellent
4- Very Good
3- Good
2- Needs Improvement
1- Poor
VERIFICATION
Please enter any two digits
Example: 12
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