Patient Satisfaction Survey

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* Date and time of your visit:

Date / Time

Date

Time

AM/PM

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* Which of our clinics did you visit?

1568 Ouellette Ave, Windsor

1275 Walker Rd, Unit 4. Windsor

(TMC Main building) 13278 Tecumseh Rd. E. Suite 106. Tecumseh

(TMC front building) 13278 Tecumseh Rd. E. Suite 10. Tecumseh

186 Talbot St. S. Essex

445 Grand Ave West. Chatham

700 Tecumseh Rd E Suite 102. Windsor

2464 Howard Ave Suite 102. Windsor

3850 Dougall Ave Unit 20. Windsor

2825 Lauzon Pky Unit 213. Windsor

2125 Front Rd.N. Unit 5. LaSalle

857 Grand Ave .W. Unit 112 Chatham

(Pain Clinic) 13278 Tecumseh Rd. E. Suite 203. Tecumseh

Question Title

* What was the purpose of your visit? (Select all that apply)

Ultrasound

X-Ray

Mammography

BMD

Nuclear Medicine

Pain Clinic

Vein Clinic

Appointment booking / registration:

Question Title

* 1. Ease of making appointments by phone

N/A

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* 2. Appointment available within a reasonable amount of time

N/A

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* 3. I received clear instructions to prepare for my appointment

N/A

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* 4. The administrative staff welcomed me upon arrival and assisted me in a timely manner

N/A

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* 5. Considering the number of patients in the waiting room, I waited an acceptable amount of time

N/A

Our Staff:

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* 6. The kindness and professionalism of the person who took your call

N/A

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* 7. The friendliness and professionalism of the receptionist

N/A

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* 8. The caring and concern of our technologists

N/A

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* 9. The medical staff answered my questions

N/A

Your Exam:

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* 10. I felt my privacy was being respected throughout my visit

Yes

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* 11. The technologist introduced themselves, and explained the test I was going to have in a manner I could easily understand

Yes

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* 12. I felt confident in the service I received

Yes

Our Facility:

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* 13. The clinic was easy to find

N/A

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* 14. Overall comfort

N/A

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* 15. Cleanliness

N/A

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* 16. Adequate parking

N/A

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* 17. Signage and direction easy to follow

N/A

Your Experience:

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* 18. The overall experience met or exceeded my expectations

Yes

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* 19. I would recommend Clear Medical Imaging to my friends and family

Yes

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* 20. If you would like to provide any additional comments or information regarding how we could improve our service or if you would like to acknowledge the exceptional service provided by one of our staff members, please use the space provided below.

** Your comments will remain anonymous, however should you wish to share your experience with one of our team members and be entered into our monthly draw, please provide your name and phone number.

Question Title

* Contact Information:

Name

Phone Number