MANA Imaging Survey

	Very Unsatisfied	Unsatisfied	Satisfied	Somewhat Satisfied	Very Satisfied
Is the scheduling system easy to use?	Is the scheduling system easy to use? Very Unsatisfied	Is the scheduling system easy to use? Unsatisfied	Is the scheduling system easy to use? Satisfied	Is the scheduling system easy to use? Somewhat Satisfied	Is the scheduling system easy to use? Very Satisfied
Were you able to schedule your patient in a timely manner?	Were you able to schedule your patient in a timely manner? Very Unsatisfied	Were you able to schedule your patient in a timely manner? Unsatisfied	Were you able to schedule your patient in a timely manner? Satisfied	Were you able to schedule your patient in a timely manner? Somewhat Satisfied	Were you able to schedule your patient in a timely manner? Very Satisfied
Was the patient’s report received promptly?	Was the patient’s report received promptly? Very Unsatisfied	Was the patient’s report received promptly? Unsatisfied	Was the patient’s report received promptly? Satisfied	Was the patient’s report received promptly? Somewhat Satisfied	Was the patient’s report received promptly? Very Satisfied
Were you treated in a helpful manner?	Were you treated in a helpful manner? Very Unsatisfied	Were you treated in a helpful manner? Unsatisfied	Were you treated in a helpful manner? Satisfied	Were you treated in a helpful manner? Somewhat Satisfied	Were you treated in a helpful manner? Very Satisfied
Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.)	Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Very Unsatisfied	Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Unsatisfied	Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Satisfied	Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Somewhat Satisfied	Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Very Satisfied
How would you rate our overall service based on your experience?	How would you rate our overall service based on your experience? Very Unsatisfied	How would you rate our overall service based on your experience? Unsatisfied	How would you rate our overall service based on your experience? Satisfied	How would you rate our overall service based on your experience? Somewhat Satisfied	How would you rate our overall service based on your experience? Very Satisfied
How would you rate our overall service based on your patient's input?	How would you rate our overall service based on your patient's input? Very Unsatisfied	How would you rate our overall service based on your patient's input? Unsatisfied	How would you rate our overall service based on your patient's input? Satisfied	How would you rate our overall service based on your patient's input? Somewhat Satisfied	How would you rate our overall service based on your patient's input? Very Satisfied

Very Unsatisfied

Unsatisfied

Satisfied

Somewhat Satisfied

Very Satisfied

Is the scheduling system easy to use?

Is the scheduling system easy to use? Very Unsatisfied

Is the scheduling system easy to use? Unsatisfied

Is the scheduling system easy to use? Satisfied

Is the scheduling system easy to use? Somewhat Satisfied

Is the scheduling system easy to use? Very Satisfied

Were you able to schedule your patient in a timely manner?

Were you able to schedule your patient in a timely manner? Very Unsatisfied

Were you able to schedule your patient in a timely manner? Unsatisfied

Were you able to schedule your patient in a timely manner? Satisfied

Were you able to schedule your patient in a timely manner? Somewhat Satisfied

Were you able to schedule your patient in a timely manner? Very Satisfied

Was the patient’s report received promptly?

Was the patient’s report received promptly? Very Unsatisfied

Was the patient’s report received promptly? Unsatisfied

Was the patient’s report received promptly? Satisfied

Was the patient’s report received promptly? Somewhat Satisfied

Was the patient’s report received promptly? Very Satisfied

Were you treated in a helpful manner?

Were you treated in a helpful manner? Very Unsatisfied

Were you treated in a helpful manner? Unsatisfied

Were you treated in a helpful manner? Satisfied

Were you treated in a helpful manner? Somewhat Satisfied

Were you treated in a helpful manner? Very Satisfied

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.)

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Very Unsatisfied

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Unsatisfied

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Satisfied

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Somewhat Satisfied

Have you been supplied with all the materials necessary to assist your patients with their appointment? (i.e. educational materials, directions, etc.) Very Satisfied

How would you rate our overall service based on your experience?

How would you rate our overall service based on your experience? Very Unsatisfied

How would you rate our overall service based on your experience? Unsatisfied

How would you rate our overall service based on your experience? Satisfied

How would you rate our overall service based on your experience? Somewhat Satisfied

How would you rate our overall service based on your experience? Very Satisfied

How would you rate our overall service based on your patient's input?

How would you rate our overall service based on your patient's input? Very Unsatisfied

How would you rate our overall service based on your patient's input? Unsatisfied

How would you rate our overall service based on your patient's input? Satisfied

How would you rate our overall service based on your patient's input? Somewhat Satisfied

How would you rate our overall service based on your patient's input? Very Satisfied

Question Title

* 2. Which modalities do you currently use? Please check all that apply.

X-Ray

Ultrasound

3T MRI

Mammography

Breast MRI

DEXA

Varicose Vein Treatment (Venous Reflux)

Other (please specify)

Question Title

* 3. Would you utilize other modalities? Please check all that apply.

X-Ray

Ultrasound

3T MRI

Mammography

Breast MRI

DEXA

Varicose Vein Treatment (Venous Reflux)

	1	2	3	4	5	6
Confidence in Radiologists	Confidence in Radiologists 1	Confidence in Radiologists 2	Confidence in Radiologists 3	Confidence in Radiologists 4	Confidence in Radiologists 5	Confidence in Radiologists 6
Location	Location 1	Location 2	Location 3	Location 4	Location 5	Location 6
Easy Scheduling	Easy Scheduling 1	Easy Scheduling 2	Easy Scheduling 3	Easy Scheduling 4	Easy Scheduling 5	Easy Scheduling 6
Quality Image	Quality Image 1	Quality Image 2	Quality Image 3	Quality Image 4	Quality Image 5	Quality Image 6
Patient Comfort	Patient Comfort 1	Patient Comfort 2	Patient Comfort 3	Patient Comfort 4	Patient Comfort 5	Patient Comfort 6
Report Turnaround	Report Turnaround 1	Report Turnaround 2	Report Turnaround 3	Report Turnaround 4	Report Turnaround 5	Report Turnaround 6

Confidence in Radiologists

Confidence in Radiologists 1

Confidence in Radiologists 2

Confidence in Radiologists 3

Confidence in Radiologists 4

Confidence in Radiologists 5

Confidence in Radiologists 6

Location

Location 1

Location 2

Location 3

Location 4

Location 5

Location 6

Easy Scheduling

Easy Scheduling 1

Easy Scheduling 2

Easy Scheduling 3

Easy Scheduling 4

Easy Scheduling 5

Easy Scheduling 6

Quality Image

Quality Image 1

Quality Image 2

Quality Image 3

Quality Image 4

Quality Image 5

Quality Image 6

Patient Comfort

Patient Comfort 1

Patient Comfort 2

Patient Comfort 3

Patient Comfort 4

Patient Comfort 5

Patient Comfort 6

Report Turnaround

Report Turnaround 1

Report Turnaround 2

Report Turnaround 3

Report Turnaround 4

Report Turnaround 5

Report Turnaround 6

MANA Imaging Survey

Clinic Experience

Question Title

* 1. Please rate your experience with our staff in terms of their importance to your clinic's needs.

Question Title

* 2. Which modalities do you currently use? Please check all that apply.

Question Title

* 3. Would you utilize other modalities? Please check all that apply.

Question Title

* 4. What influences your decision where you send your patients for imaging? Please rate these items in order 1 as most important to 6 as least important.