1. Please enter the date of your appointment.

2. What facility did you visit?

3. Was the person scheduling your appointment courteous, helpful and knowledgeable?

4. Was the person who registered you courteous and helpful?

5. Did you feel you were treated professionally, respectfully and with compassion?

6. Did your technologists/nurse thoroughly explain your exam?

7. What kind of exam did you receive?

8. Did you feel your exam was performed in a timely manner? Please explain.

9. Did you feel our facility was clean and comfortable?

10. Did we communicate with your family/friends in a timely manner?

11. Would you return for further treatments/tests?

12. What recommendations would you make for our facility?

13. If you would like to be contacted regarding your experience in our facility please complete your name, phone number and email address below.

14. We continually strive to improve our services. Please check which of the below items are important to you.