* 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.

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