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Iowa Radiology Patient Survey
4.
2 minute survey
1.
Which location did you visit?
Clive -- Stratford Drive
Downtown Des Moines -- Stoddard
West Des Moines -- Lakeview
Ankeny
2.
Please select the radiology imaging services you received.
MRI
CT Scan
Ultrasound
Mammography
Bone Density Scan
Fluoroscopy
General X-Ray
Other
3.
How did you hear about our facility
Physician referral
Friend or Relative
TV
Radio
Newspaper
Magazine
Billboard
Event in the Community
Community Greetings -- Welcome Wagon
Internet
Other (please specify)
4.
Was this the first visit to our clinic?
yes
no
5.
Registration and Scheduling
Very Good
Good
Fair
Poor
Very Poor
1. Was the receptionist friendly and knowledgeable?
Very Good
Good
Fair
Poor
Very Poor
2. Ease in registering or making your appointment.
Very Good
Good
Fair
Poor
Very Poor
Other (please specify)
6.
Your Experience
Very Good
Good
Fair
Poor
Very Poor
1. Was the technologist professional and friendly?
Very Good
Good
Fair
Poor
Very Poor
2. Was the information provided clear and complete?
Very Good
Good
Fair
Poor
Very Poor
3. Were we sensitive to your comfort and needs?
Very Good
Good
Fair
Poor
Very Poor
Other (please specify)
7.
Overall Assessment of Experience and Facility
Very Good
Good
Fair
Poor
Very Poor
1. Was the facility clean and comfortable?
Very Good
Good
Fair
Poor
Very Poor
2. Overall rating of the care you received during your visit.
Very Good
Good
Fair
Poor
Very Poor
3. Likelihood of recommending our facility to others.
Very Good
Good
Fair
Poor
Very Poor
Other (please specify)
8.
Was anyone expecially helpful?
9.
Contact Information
Patient's Name (Optional)
Patient's Phone Number (Optional)