Patient Survey Question Title * 1. Date and time of appointment Question Title * 2. Was the scheduled time convenient for you? Yes No Question Title * 3. Which imaging center did you visit? 811 O'Hare Parkway (Navigator's Landing, across from Airport) 1107 Crater Lake Avenue (Providence Hospital, Adjacent to ER) 870 S. Front Street, Central Point (Providence Medical Group) Question Title * 4. Why did you choose to come to OAI? It's close to my home/work/business Another patient referred me My doctor referred me I'm a return patient Advanced technology Other (please specify) Question Title * 5. Were you able to find our office without a problem? Yes No Question Title * 6. Was your payment responsibility fully explained to you? Yes No Does Not Apply Question Title * 7. Was the facility comforting and welcoming? Yes No Question Title * 8. Please rate our Scheduling Department staff on the level of friendly, professional, and compassionate care they provide. Excellent Average Poor Question Title * 9. Please rate our Reception staff on the level of friendly, professional, and compassionate care they provide. Excellent Average Poor Question Title * 10. Please rate our Technologist staff on the level of friendly, professional, and compassionate care they provide. Excellent Average Poor Question Title * 11. Please rate our Nursing staff on the level of friendly, professional, and compassionate care they provide. Excellent Average Poor N/A, I did not require a Registered Nurse for my scan Question Title * 12. Did our Reception staff maintain your privacy during your visit? Yes No Question Title * 13. Did our Technologist staff maintain your privacy during your visit? Yes No Question Title * 14. Did our Nursing staff maintain your privacy during your visit? Yes No N/A, I did not require a Registered Nurse for my scan. Question Title * 15. What was your overall impression of OAI and the services we provide? Excellent Average Poor Question Title * 16. Do you have any comments? Question Title * 17. Your name and phone number (optional): Done
