Patient Survey

Instructions: Please rate your agreement with the following statements based on your recent surgical experience, in only the center noted above. We welcome your comments as they help us learn about your experience and care.

Overall, I am very confident that in the care I received at Prime Surgical Center of Encino. *

Strongly Agree Agree Disagree Strongly Disagree

Using any number from 0 to 10, where 10 is the best surgeon possible and 0 is the worst surgeon possible, what number would you use to rate your surgeon? *

Using any number from 0 to 10, where 10 is the best facility possible and 0 is the worst facility possible, what number would you use to rate your care at this facility during your stay? *

Using any number from 0 to 10, where 10 means you are highly likely to recommend this facility and 0 means you are not likely to recommend this facility, please rate how likely you are to recommend this facility to family and friends? *

What did you like best about Prime Surgical Center? *

What did you like the least about Prime Surgical Center? *

Are you the patient? *

Yes No

Patient's Gender *

Male Female

Patient's age group: *

If you would like to be contacted to discuss any negative responses you may have provided, please select 'Yes' and provide full contact information below.

Your name (Optional): *

Your phone number (Optional): *

Your email (Optional): *

If you have any medical questions or concerns, please contact your surgeon's office.

​Patient Survey

Patient Survey