FROC MRI Patient Satisfaction Survey

1. MRI Patient

Thank you for your assistance. It is our goal to use this information to better serve our customers. If you wish to speak to someone regarding your care or would like to file a formal grievance, please fill in the information below or contact our CEO, Dave Demchuk at ddemchuk@frocmd.com

1. Provide your information below if you would like to be contacted by our CEO, Dave Demchuk.

Provide your information below if you would like to be contacted by our CEO, Dave Demchuk. Name:
Email Address:
Phone Number:

2. Please answer the questions below describing your experience with our MRI facility.

	Strongly Agree	Agree Somewhat	Disagree Somewhat	Strongly Agree
Was scheduling your MRI easy?	Please answer the questions below describing your experience with our MRI facility. Was scheduling your MRI easy? Strongly Agree	Was scheduling your MRI easy? Agree Somewhat	Was scheduling your MRI easy? Disagree Somewhat	Was scheduling your MRI easy? Strongly Agree
Did the MRI technologist explain the procedure and answer your questions about the study appropriately?	Did the MRI technologist explain the procedure and answer your questions about the study appropriately? Strongly Agree	Did the MRI technologist explain the procedure and answer your questions about the study appropriately? Agree Somewhat	Did the MRI technologist explain the procedure and answer your questions about the study appropriately? Disagree Somewhat	Did the MRI technologist explain the procedure and answer your questions about the study appropriately? Strongly Agree
Were you comfortable during the MRI?	Were you comfortable during the MRI? Strongly Agree	Were you comfortable during the MRI? Agree Somewhat	Were you comfortable during the MRI? Disagree Somewhat	Were you comfortable during the MRI? Strongly Agree
Would you recommend family/friends to our MRI facility?	Would you recommend family/friends to our MRI facility? Strongly Agree	Would you recommend family/friends to our MRI facility? Agree Somewhat	Would you recommend family/friends to our MRI facility? Disagree Somewhat	Would you recommend family/friends to our MRI facility? Strongly Agree

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