Patient Satisfaction Survey

We are pleased that you and your doctor chose Outpatient Surgery Center of Jonesboro. Our goal is to provide high quality care for you and your family. Your evaluation will be thoroughly reviewed and kept confidential.

Please select from one of the four options below to complete the survey:

Online Form

Online Survey
Click here or scroll down to complete our online patient satisfaction survey online.

Mail

Download the survey PDF file
Print and complete
Mail the completed form to our office.

Print/Scan/Email

Download the survey PDF file
Print and complete
Scan
Email the completed PDF to Leah Soffray

Print/Fax

Download the survey PDF file
Print and complete
Fax the completed form to 870-932-6435

Step 1 of 3 - Your Info & Overall Impression

Patient Name
Date of Service
Account Number

Please indicate your overall impression of OSC based upon the service you received during your outpatient visit.

Excellent
Above Average
Average
Below Average
Poor

If your overall impression was not "Excellent", what would it take to make it "Excellent"?

Step 2 of 3 - Would You Recommend?

Why did you choose Outpatient Surgery Center of Jonesboro?

Friend
Family Member
Advertisement
Physician
Surgeon
Other

Would you recommend Outpatient Surgery Center of Jonesboro to a good friend who lives in this area, has a medical problem similar to your, and need outpatient surgery?

Yes
No
Not Sure

If "No" or "Not Sure", why?

Step 3 of 3 - Rate Our Services

How would you rate the following? (5 = Excellent, 1 = Poor)

Admissions	5	4	3	2	1
Pre-Admission visit and/or phone call was clear
Admissions person demonstrated courtesy and concern
Billing and insurance information was clear
Waiting Time before being taken to Pre-Op reasonable

Pre-Op	5	4	3	2	1
Pre-Op personnel demonstrated courtesy and concern
IV was administered without excessive discomfort
Clear instructions were provided prior to surgery
Anesthesiologist demonstrated courtesy and concern
Staff provided for your physical comfort in pre-op area

Operating Room/Endoscopy Suite	5	4	3	2	1
Personnel demonstrated courtesy and concern
Staff explained the preparations for the procedure
Staff provided for your physical comfort

Recovery Room	5	4	3	2	1
Recovery room nurses demonstrated courtesy and concern
Staff demonstrated concern for your privacy
Staff provided for your physical comfort
Staff provided sufficient recovery time prior to discharge
Staff provided clear explanation of discharge