Skip to main content
Menu
OAK Surgical Institute
Surgeon Directory
OAK Surgical Institute (OSI) Surgery Center Services
Patient Resources
Contact Information
(815) 928-9999
Satisfaction Survey
OAK Surgical Institute
Surgeon Directory
OAK Surgical Institute (OSI) Surgery Center Services
Patient Resources
Contact Information
Patient Satisfaction Survey
Doctor's Name
*
Date of Surgery/Procedure
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2013
2014
2015
2016
2017
2018
2019
Were you treated courteously at all times?
Yes
No
Please rate how satisfied you were with your surgeon’s care.
Extremely satisfied
Satisfied
Neutral
Dissatisfied
Not at all satisfied
Please rate how satisfied you were with your anesthesiologist’s care.
Extremely satisfied
Satisfied
Neutral
Dissatisfied
Not at all satisfied
Were your discharge instructions clear and helpful?
Yes
No
How would you rate your comfort level in the recovery area?
Excellent
Very Good
Good
Fair
Poor
How would you rate the preoperative and postoperative care?
Excellent
Very Good
Good
Fair
Poor
How would you rate the office staff’s willingness to work with your insurance and payment situation?
Excellent
Very Good
Good
Fair
Poor
Did everyone introduce themselves prior to caring for you?
Yes
No
In your preoperative phone call, how would you rate the nurse’s explanation and answers to your questions about surgery?
Excellent
Very Good
Good
Fair
Poor
How likely are you to use OAK Surgical Institute for further surgery needs?
Extremely likely
Likely
Unsure
Unlikely
Not at all likely
Were there any problems you didn’t anticipate?
Yes
No
If yes, please explain:
How could we have made your visit more pleasant?
If you would like a representative from OAK Surgical Institute to call you, please give us your:
Name
Telephone Number
Convenient Time to Call
Submit
