Patient Feedback Form – CSTAR International

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 *

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 *

Explanations the coordinator gave you about your surgical journey *

Explanations the coordinator gave you about your quote, payment, and cancellation process *

Concern the coordinator showed for your concerns or worries *

How was the communication and the follow-up care during your surgical journey? *

Amount of time your coordinator spent with you *

Your confidence in your coordinator *

Likelihood of your recommending CSTAR International to others *

Please tell us how was the experience with your CSTAR International coordinator? *

DOCTOR'S REVIEW

How was your Experience upon arrival at the clinic? *

The Administrative staff was polite, courteous, and respectful *

Friendliness/courtesy of the Doctor *

Explanations the doctor gave you about your surgery *

Doctor's efforts to include you in decisions about your procedures *

Information the doctor gave you about medications (If any) *

Your confidence in this Doctor *

Skills of assisting staff, for example when taking care of you after sugery *

Likelihood of your recommending this doctor to others *

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? *

The Administrative staff was polite, courteous, and respectful *

Was the room comfortable and clean? *

The care and attention of the nurses *

Taste and quality of the food *

Common areas were clean, comfortable, and accessible *

Attitude, performance, and punctuality of the driver *

Likelihood of your recommending this Recovery Facility to others *

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

Overall how whould you rate your entire surgical jorney *

VERIFICATION

Please enter any two digits

Example: 12