Thank you for visiting us at somniaanesthesiaservices.com - we appreciate your feedback. Please note that with the submission of your survey (by the required date), you will automatically receive a $20 Barnes & Noble Gift Card.

	What is your email? (must provide in order to receive your $20 gift card)

	Describe your facility:
	Office-based operating room
	State licensed surgery center
	Hospital
	Women's Center
	Correctional Facility

	Facility Accreditation:
		Yes		No		N/A
	Is your facility accredited?
	Would you be interested in becoming accredited?
	Did you know that we offer accreditation assistance?

	What is your role at the facility?
	Surgeon
	Administrator
	Nurse Manager
	Nurse
	Other

	Have you ever contacted a Somnia representative?
	Yes
	No

	What issue(s) did you call about? (please choose all that apply)
	Billing
	Business/Client Development
	Staffing/Scheduling
	Credentialing
	Clinical
	Logistics
	Legal

	Was your issue resolved in a complete and timely fashion?
	Yes
	No

	Comments:

	How many days a week do you use our services on average?
	--Click Here--less than 1 day1 day2 days3 days4 days5 days6 days7 days

	As it pertains to clinical services provided by our clinicians:
		Excellent		Very Good		Good		Fair		Poor		N/A
	Quality of clinical services
	Bedside manner
	Punctuality
	Tidiness
	Teamwork
	Case turnover
	Post anesthesia care

	Have case cancellations adversely affected your practice?
	Yes
	No

	Has our ability to cover cases after regular hours adversely affected your practice?
	Yes
	No

	As it pertains to our Scheduling staff:
		Excellent		Very Good		Good		Fair		Poor		N/A
	Availability
	Professionalism
	Timeliness

	As it pertains to our Billing staff:
		Excellent		Very Good		Good		Fair		Poor		N/A
	Availability
	Professionalism
	Timeliness
	Accuracy of information

	As it pertains to our Logistics staff:
		Excellent		Very Good		Good		Fair		Poor		N/A
	Availability
	Professionalism
	Scheduling of supply replenishment

	What was your overall level of satisfaction with our services?
	Very satisfied
	Satisfied
	Dissatisfied
	Very dissatisfied

	Would you recommend us to a colleague?
	Yes
	No

	Why or why not?

	Can we use your responses on future company materials?
	Yes
	No

Survey is not complete until you click the SUBMIT button below. Thank you for your time.