Pediatric Satisfaction Survey

Patient Satisfaction is very important to The Day Surgery at RiverBend. We would like your help to identify areas that need improvement. Please take a few minutes to answer the following questions. Thank you for your time!

Demographic Information

Optional Information

The Day Surgery at RiverBend is required by law to maintain the privacy of your medical information. We are also required to notify you of our legal duties and privacy practices regarding your medical information. All information submitted to our website using our forms is encrypted for transmission using Secure Socket Layer (SSL) protocol and 128-bit encryption. SSL is used for transmitting personal demographic information, personal health information and credit card information.