It is our goal to give you the best possible medical care. To do so, it is important that we know your thoughts about the care you are receiving. We need to know what we are doing right and in what areas we can improve. Your comments will be strictly confidential. Thank you!

* 1. Visit Date:

* 2. Technologist Name:

* 3. MRI Assistant Name:

* 4. Overall, what type of service did you receive?

* 5. Did the MRI staff answer all your questions prior to, during, and after your MRI?

* 6. How informed did you feel about the procedure?

* 7. Did your MRI technologist and assistant make you comfortable for your scan?

* 8. Did you enjoy the option of listening to music during your scan?

* 9. Was your MRI scheduled in a timely manner? (Please keep in mind the pre-authorization process that is needed for most insurances)

* 10. What could the MRI department do better?

* 11. Additional Comments:

* 12. Name and Phone Number (Optional)