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