Survey

Age

What is your preferred language?*

Did you have a language barrier?*

Were you born in the United States?*

Did the language barrier impact your care or outcome?*

Strongly agree	Agree	Disagree	Strongly disagree

Please select all that apply to indicate what impact the language barrier had on you.*

Race*

Tobacco use*

Yes	No	Quit

Alcohol use*

Please select whether your surgery was inpatient or outpatient.*

Number of days stayed for inpatient.*

Were you admitted to a hospital after surgery?*

Did you have any of these post-operative complications?*

Did you think you received high value Healthcare in this office?*

Glasgow Pain Scale: How would you rate your pain today?