Radiology Department
Excelsior Springs Hospital

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* 1. How satisfied are you with the overall experience of your exam?

Excellent

Good

Fair

Poor

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* 2. How likely are you to recommend our services to your friends and family?

Highly Likely

Likely

Not Likely

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* 3. What exam did you have performed? (Please mark all that apply)

CT (Computed Tomography)

MRI (Magnetic Resonance Imaging)

US (Ultrasound including Echocardiograms)

Mammography

Bone Density

X-Ray

Other (please specify)

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* 4. The staff were professional and friendly:

Yes

If No, please specify

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* 5. Were you provided with clear instructions during your exam?

Yes

If No, please specify

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* 6. Do you have any suggestions on how we can improve your experience?

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* 7. Date of visit (optional)

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* 8. Contact information (optional)

Name

Phone number

Email address

Thank you for taking the time to fill out our survey so that we may improve our services to our patients. Your suggestions are very important to us.

If you have additional information or concerns please feel free to contact:

Director of Radiology

816-629-2757