COVID-19 and Vaccine Updates
Find a Doctor
Services
Services
Bone, Joint & Spine Care
Cancer Care
Digestive Diseases
Emergency Care
Heart and Vascular Care
Women and Children's Health
Primary Care
Weight Loss Surgery
View All
View All Conditions
View All Medical Services
Patients & Visitors
Visitors and Families
Visiting Hours/Guidelines
Directions
Parking
Hospital Maps
Contact Patients
Patient Greeting Card
Hospital Amenities
Dining
Gift Shop
Hotel Accommodations
Integrative Medicine
Pharmacy
Spiritual Care
For Patients
Billing
Medical Records
Preparing for Surgery (Emmi)
Patient Relations
Patient Portal
Pay My Bill
Giving
Careers
Contact Us
Nuvance Health
Search
Menu
Surgery Survey
Thank you for choosing Norwalk Hospital for your surgery. Norwalk Hospital is a member of the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP). We are gathering information on the outcomes of our patients and how they have been feeling since their surgery.
Cycle Number
Case Number
Have you been to a hospital or seen by a doctor for any reason since your surgery?
Yes
No
If you answered NO, you do not need to answer any more questions. If you have answered YES, please answer the following questions.
Have you been seen in an outpatient clinic or doctor’s office after your surgery?
Yes
No
If yes, was this visit for routine follow-up?
Yes
No
If no, what was the reason for your visit?
Date(s) of visit(s)
Have you experienced any health problems since your surgery?
Yes
No
If yes, please explain
Did you go to an Emergency Department (ED) or hospital after your surgery?
Yes
No
Were you admitted?
Yes
No
If yes, please explain
Date(s) of ED visit or hospitalization
Did you have any additional surgery(ies) during this hospitalization?
Yes
No
If yes, what type of surgery(ies) did you have?
Date(s) of surgery(ies)
