Patient Satisfaction Survey

We are committed to providing excellent, compassionate and patient focused care. In fulfilling this commitment your feedback is invaluable.   Hearing from you will allow us to further enhance our services to better serve you as a patient.  Thank-you in advance for your time in filling out this survey and your feedback.

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* 1. Please enter the date of your visit:

Date

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* 2. What was the time of your appointment?

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* 3. Please select the clinic that you visited;

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* 4. What was the reason for your visit, please check all which apply.

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* 5. Help us ensure that the team members who helped you, receive the feedback by leaving your name. 

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* 6. I was able to get a scheduled appointment within an acceptable amount of time.  

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* 7. When I arrived for my appointment, I was greeted and attended to by the receptionist in a timely manner.

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* 8. The information and instructions provided in preparation for my appointment were useful and beneficial.

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* 9. The check-in process was efficient.

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* 10. The reception staff treated me in a professional and courteous manner.

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* 11. My wait from check-in to the actual start of my test was acceptable.

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* 12. The technologist responsible for my exam or procedure was courteous and professional with me.

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* 13. My technologist was helpful in explaining the procedure and in answering any questions.

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* 14. The clinic's physical environment was clean, well maintained and appealing.

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* 15. I was thanked by a staff member before I left from my appointment.

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* 16. My personal privacy and health information privacy was considered throughout my visit (ie. during registration, while changing, during my exam, etc.) .

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* 17. Overall, I was satisfied with my most recent experience at a Wentworth-Halton X-Ray & Ultrasound clinic and with the quality of care provided.

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* 18. I would recommend Wentworth-Halton X-ray & Ultrasound to my family and friends?

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* 19. Would you be willing to be contacted directly by a Customer Service representative from Wentworth-Halton X-Ray & Ultrasound?

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* 20. If you have any other comments or suggestions, please feel free to provide them here.

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