Zwanger-Pesiri Patient Survey
Appointment Satisfaction
Rate on a scale of 1-5, 5 Stars being the highest (excellent) and 1 Star being the lowest (very poor).
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1.
When you made your appointment, how would you rate the scheduler’s kindness and helpfulness?
(Required.)
1 star
2 stars
3 stars
4 stars
5 stars
Additional comments or feedback for the person who scheduled your appointment (optional)
*
2.
During your visit, how would you rate the front desk staff's kindness and helpfulness?
(Required.)
1 star
2 stars
3 stars
4 stars
5 stars
Additional comments or feedback for the front desk staff (optional)
*
3.
The technologist(s) that performed your exam(s), how would you rate their kindness, knowledge, professionalism and helpfulness?
(Required.)
1 star
2 stars
3 stars
4 stars
5 stars
Additional comments or feedback for the technologist(s) that performed your exam(s) (optional)
4.
If a nurse placed an IV line prior to your exam, how would you rate their kindness and helpfulness? (Please leave Blank/Empty if not applicable)
1 star
2 stars
3 stars
4 stars
5 stars
Additional comments or feedback for the nurse that placed your IV (optional)
50%