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What imaging service(s) did you receive?

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* 1. What imaging service(s) did you receive?

Which practice did you attend?

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* 2. Which practice did you attend?

How did you book your appointment?

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* 3. How did you book your appointment?

How do you rate our booking system?

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* 4. How do you rate our booking system?

Name of the imaging staff who did the imaging for you?

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* 5. Name of the imaging staff who did the imaging for you?

How satisfied are you with the following experiences?

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* 6. How satisfied are you with the following experiences?

  Very Satisfied Satisfied Neutral Dissatisfied
Friendliness of imaging staff
Professionalism of imaging staff
Friendliness of reception staff
Parking
Please tell us how long you waited in reception before your examination.

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* 7. Please tell us how long you waited in reception before your examination.

How can we improve our services?

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* 8. How can we improve our services?

How did you hear about us? (check all that apply)

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* 9. How did you hear about us? (check all that apply)

Why did you choose us? (check all that apply)

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* 10. Why did you choose us? (check all that apply)

Would you like us to contact you regarding your feedback?

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* 11. Would you like us to contact you regarding your feedback?

Contact Information (optional)

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* 12. Contact Information (optional)

How important is bulk billing to you?

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* 13. How important is bulk billing to you?

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