Discharge Questionnaire

With a goal of offering the best possible experience for patients undergoing plastic and or reconstructive surgery, Dr Anne would value your frank opinion and feedback following your recent operation and subsequent recovery.

Your feedback is particularly important to her as your perspective of the entire process will help drive any refinements necessary to achieve the highest standards of surgery and overall patient management.

The information collected in this survey will not be shared with third parties. Your responses to this survey will remain private and confidential. For added security and peace of mind, this website is secured with end-to-end encryption to further protect your information.

Thank you for taking the time to answer these questions. If you have had more than one operation with Dr Anne, please complete this survey based on your most recent surgical procedure.

"*" indicates required fields

Step 1 of 3 - About You

33%

Q1. Are you?*

Male

Female

I prefer not to say

Q2. How old are you?*

18-30 years

31-50 years

51-70 years

71+ years

I prefer not to say

Q3. How was your treatment funded?*

Health Insurance

Self-pay

Other

If other, please specify how your treatment was funded*

Q4. What surgical procedure did you have with Dr Dancey?*

Q5. Where did you have your surgery?*

Cayman Surgery Clinic

The Doctors Hospital

Q6. How many surgeries have you had with Dr Dancey?*

This is my first

Two

Three

Four

Five or more

Q7. How did you hear about Dr Dancey and the services she offers?*

(You may make multiple selections)

Word of mouth

Returning patient

Website review

Television

Magazine

Recommendation from another patient

Search engine

Hospital promotion or event

Newspaper

Professional referral

Q8. Did you consult with another surgeon prior to electing to have surgery with Dr Dancey?*

Yes

Word of mouth: Please specify if friend, family or other

Website review: Please specify which site

Q9. What made you decide to select Dr Dancey as your surgeon?*

Q10. During your initial consultation with Dr Dancey:

Q10.1 Were you made to feel comfortable?*

Yes

Q10.2 Were your questions answered fully?*

Yes

Q10.3 Was there enough time allowed for the consultation?*

Yes

Q10.4 Did the clinic room meet your expectations and offer enough privacy when discussing your condition or treatment?*

Yes

Q10.5 Was the information on Dr Dancey’s website helpful?*

Yes

I did not access it

Q10.6 Did you receive enough correspondence from Dr Dancey?*

Yes

Q10.7 Did you feel sufficiently involved in decisions about your care and treatment?*

Yes

Q10.8 Please indicate if there is anything we could improve for you?

Q11. Were you satisfied with service provided by the following staff (if applicable)?

Q11.1 Cayman Surgery Receptionist*

Yes

No (Please explain in the space below)

Please let us know why you were dissatisfied*

Q11.2 Plastic Surgery Clinic Nurse*

Yes

No (Please explain in the space below)

Not applicable

Please let us know why you were dissatisfied*

Please name your Plastic Surgery Clinic Nurse if you can remember

Q11.3 Dr Tanja Ebanks (if she was involved in your care)*

Yes

No (Please explain in the space below)

Not applicable

Please let us know why you were dissatisfied*

Q11.4 Physiotherapist / Lymphoedema Nurse*

Yes

No (Please explain in the space below)

Not applicable

Please let us know why you were dissatisfied*

Please name your Physiotherapist / Lymphoedema Nurse if you can remember

Q11.5 Hospital Financial Team (quotations, invoicing and payment)*

Yes

No (Please explain in the space below)

Please let us know why you were dissatisfied*

Q11.6 Anaesthetist*

Yes

No (Please explain in the space below)

Please name your Anaesthetist if you can remember

Please let us know why you were dissatisfied*

Q11.7 Operating Theatre Nurses*

Yes

No (Please explain in the space below)

Please name your Operating Theatre Nurses if you can remember

Please let us know why you were dissatisfied*

Q11.8 Ward Nurses*

Yes

No (Please explain in the space below)

Please name your Ward Nurses if you can remember

Please let us know why you were dissatisfied*

Q12. Did you feel that your discharge from clinic/hospital was well planned and coordinated?*

Yes

No (Please explain in the space below)

Please let us know why you were dissatisfied*

Q13. How many weeks have passed since your surgical procedure?

Q14. How do you assess the quality of your result?*

Excellent

Very good

Good

Fair

Poor (Please explain in the space below)

Please explain why you feel your result is poor*

Q15. How would you describe your overall surgical experience with Dr Dancey?*

Excellent

Very good

Good

Fair

Poor (Please explain in the space below)

Please explain why you feel your overall experience was poor*

Q16. Did you suffer any post-operative complications that required medical intervention or re-admission after your discharge from hospital?*

Yes (Please explain in the space below)

Yes: Please provide details below

Q17. Were you happy with the support received from Dr Dancey for any post-operative concerns/complications you may have had?*

Yes

No (Please explain in the space below)

Not applicable

No: Please provide feedback as to why you were unhappy*

Q18. If, in the future, you require further surgery by a plastic/reconstructive surgeon will you consider returning to Dr Dancey?*

Yes

No (Please explain in the space below)

Please explain why you wouldn't consider Dr Dancey for future surgery*

Q19. Would you recommend Dr Dancey to a friend, relative or colleague?*

Yes

Q20. Please give details of any other aspects of your surgery that have not been captured in the survey that you would like to share with Dr Dancey?

Do you wish for us to contact you about your feedback?*

Yes

Please leave your name if you wish us to contact you about your feedback (otherwise leave blank)

Name

First Last

Email*

Cellphone / Mobile

Thank you once again for taking the time to complete this survey.

This field is for validation purposes and should be left unchanged.

Discharge Questionnaire

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