1.How often did care providers treat you with courtesy and respect?

Never

Sometimes

Usually

Always

2.How often did care providers explain things in a way you could understand?

Never

Sometimes

Usually

Always

3.Did you feel that there was good communication about your care between doctors, nurses and other hospital staff?

Never

Sometimes

Usually

Always

Don’t know/Not sure

4.Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit?

Never

Sometimes

Usually

Always

Not Applicable

5.Did care providers do everything they could to ease your discomfort or symptoms?

No

Yes, somewhat

Yes, mostly

Yes

Not applicable

6.Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

Not at all

Partly

Quite a bit

Completely

7.Overall… (Please circle a number)

0 - I had a very poor experience

1

2

3

4

5

6

7

8

9

10 – I had a very good experience

8.Were there any barriers (physical, language, accessibility) that made it difficult to access services? (Comment if there were barriers)

9.What else would you like to say about your diagnostic imaging experience?