We want to "C" what you think! Survey

Question Title

* 1. Which clinic did you visit?

Question Title

* 2. What day was your exam?

Date

Question Title

* 3. What type(s) of exam/procedure did you have? (You may select more than one)

Ultrasound

Mammogram

Pain Management Injection

Barium Swallow (UGI)

Bone Mineral Densitometry

X-Ray

MRI

Other

Question Title

* 4. Please indicate your level of satisfaction with our booking agents and appointment services

	Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied
How satisfied were you with the courtesy and friendliness of the booking agent?	How satisfied were you with the courtesy and friendliness of the booking agent? Very Satisfied	How satisfied were you with the courtesy and friendliness of the booking agent? Satisfied	How satisfied were you with the courtesy and friendliness of the booking agent? Dissatisfied	How satisfied were you with the courtesy and friendliness of the booking agent? Very Dissatisfied
How satisfied were you with the information you received regarding your appointment from the booking agent?	How satisfied were you with the information you received regarding your appointment from the booking agent? Very Satisfied	How satisfied were you with the information you received regarding your appointment from the booking agent? Satisfied	How satisfied were you with the information you received regarding your appointment from the booking agent? Dissatisfied	How satisfied were you with the information you received regarding your appointment from the booking agent? Very Dissatisfied
How satisfied were you with the appointment availability?	How satisfied were you with the appointment availability? Very Satisfied	How satisfied were you with the appointment availability? Satisfied	How satisfied were you with the appointment availability? Dissatisfied	How satisfied were you with the appointment availability? Very Dissatisfied
How satisfied were you with the automated reminders you received prior to the date of your appointment?	How satisfied were you with the automated reminders you received prior to the date of your appointment? Very Satisfied	How satisfied were you with the automated reminders you received prior to the date of your appointment? Satisfied	How satisfied were you with the automated reminders you received prior to the date of your appointment? Dissatisfied	How satisfied were you with the automated reminders you received prior to the date of your appointment? Very Dissatisfied

If dissatisfied with any of the above, please comment why you were dissatisfied

Question Title

* 5. Please indicate your level of satisfaction with our clinic staff and service delivery

	Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied
How satisfied were you with the cleanliness of the clinic?	How satisfied were you with the cleanliness of the clinic? Very Satisfied	How satisfied were you with the cleanliness of the clinic? Satisfied	How satisfied were you with the cleanliness of the clinic? Dissatisfied	How satisfied were you with the cleanliness of the clinic? Very Dissatisfied
How satisfied were you with the overall look and feel of the clinic?	How satisfied were you with the overall look and feel of the clinic? Very Satisfied	How satisfied were you with the overall look and feel of the clinic? Satisfied	How satisfied were you with the overall look and feel of the clinic? Dissatisfied	How satisfied were you with the overall look and feel of the clinic? Very Dissatisfied
How satisfied were you with courtesy and friendliness of the front desk staff?	How satisfied were you with courtesy and friendliness of the front desk staff? Very Satisfied	How satisfied were you with courtesy and friendliness of the front desk staff? Satisfied	How satisfied were you with courtesy and friendliness of the front desk staff? Dissatisfied	How satisfied were you with courtesy and friendliness of the front desk staff? Very Dissatisfied
How satisfied were you with the technologist's explanation of the procedure?	How satisfied were you with the technologist's explanation of the procedure? Very Satisfied	How satisfied were you with the technologist's explanation of the procedure? Satisfied	How satisfied were you with the technologist's explanation of the procedure? Dissatisfied	How satisfied were you with the technologist's explanation of the procedure? Very Dissatisfied
How satisfied were you with the technologist's display of caring and concern for you?	How satisfied were you with the technologist's display of caring and concern for you? Very Satisfied	How satisfied were you with the technologist's display of caring and concern for you? Satisfied	How satisfied were you with the technologist's display of caring and concern for you? Dissatisfied	How satisfied were you with the technologist's display of caring and concern for you? Very Dissatisfied

If dissatisfied with any of the above, please comment why you were dissatisfied

Question Title

* 6. Did the doctor (Radiologist) need to speak with you or perform your procedure?

Yes