Patient Survey
1.
Date and time of appointment
2.
Was the scheduled time convenient for you?
Yes
No
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)
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)
5.
Were you able to find our office without a problem?
Yes
No
6.
Was your payment responsibility fully explained to you?
Yes
No
Does Not Apply
7.
Was the facility comforting and welcoming?
Yes
No
8.
Please rate our Scheduling Department staff on the level of friendly, professional, and compassionate care they provide.
Excellent
Average
Poor
9.
Please rate our Reception staff on the level of friendly, professional, and compassionate care they provide.
Excellent
Average
Poor
10.
Please rate our Technologist staff on the level of friendly, professional, and compassionate care they provide.
Excellent
Average
Poor
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
12.
Did our Reception staff maintain your privacy during your visit?
Yes
No
13.
Did our Technologist staff maintain your privacy during your visit?
Yes
No
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.
15.
What was your overall impression of OAI and the services we provide?
Excellent
Average
Poor
16.
Do you have any comments?
17.
Your name and phone number (optional):
