Outpatient Surgery (308) 384-6400 3610 Richmond Circle, Grand Island, NE 68803 Mon – Fri: 5:30 am – 5:00 pmFacebook Instagram

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Patient Survey

Tell us about your experience at Grand Island Surgery Center by completing our patient questionnaire. We value your opinion!

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We appreciate you having your procedure/surgery with us. Please help us improve our care. Let us know how satisfied you were in the following areas by marking the appropriate space.

Registration - Check in

Staff's courtesy & efficiency

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LowHigh

Answers to your questions

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LowHigh

Before procedure/surgery

Maintenance of privacy

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LowHigh

Concern for your well-being

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LowHigh

Length of waiting time

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LowHigh

Anesthesia

Treated with courtesy

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LowHigh

Explanation of anesthesia and side effects

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LowHigh

During procedure/surgery

Concern for your well-being

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LowHigh

Attention to your needs

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LowHigh

After procedure/surgery

Concern for your well-being

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LowHigh

Answers to your questions

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LowHigh

Maintenance of your privacy

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LowHigh

Pain control adequate

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LowHigh

Departure

Staff's courtesy & efficiency

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LowHigh

Clear discharge instructions

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LowHigh

Readiness to leave the facility

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LowHigh

Home Recovery

Recovery went as expected

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LowHigh

Overall

Family kept informed

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LowHigh

How satisfied are you with your experience at the Grand Island Surgery center overall?

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LowHigh

At home, did you experience any of the following

Fever above 101 degrees

YesNo

Abnormal bleeding/draining

YesNo

Vomiting more than 24 hours

YesNo

Pain not controlled by medication

YesNo

Did any of the above problems cause you to

Call your doctor

YesNo

Visit your doctor

YesNo

Visit the emergency room

YesNo

Return to our Center

YesNo

Comments/Suggestions

Closing questions

What influenced your decision to have your procedure/surgery performed at this Center?

Check all that apply

CostReturn home same dayLocation of facilityRecommended by friend/physicianPhysician directedPrevious experience with us

Do you have access to Internet or e-mail?

YesNo

Sex

MaleFemale

Age

0-1516-2526-3536-4546-5556-65Over 65

Procedure/Surgery Date

Today's Date

Name of Surgeon

Last Name & First Initial

Insurance Company

Name

Optional

Phone #

Optional

Our goal is to deliver quality of care in a courteous, respectful, and compassionate manner. We hope you will allow us to care for you and strive to be the first and best choice for your healthcare.

Specialties

Anesthesiology
General Surgery
Orthopedic Surgery
Pain Management
Radiology
Urology
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If you have any questions or need help, feel free to contact our team.

3610 Richmond Circle, Grand Island, NE 68803

Mon – Fri: 5:30 am – 5:00 pm

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© 2026 Grand Island Surgery Center, LLC. All Rights Reserved.PO Box 5434, Grand Island, NE 68802