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Patient Feedback Survey
Please take a few minutes to tell us about your MIC appointment. MIC is committed to continuous improvement and will use your feedback to help improve our services.
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1.
Which clinic did you visit?
(Required.)
Allin Clinic
Century Park
Gateway
Heritage Valley
Hys Centre
Lakewood
Manning Town Centre
Namao 160
Terra Losa
Windermere
Fort Saskatchewan - South Pointe
Sherwood Park - Synergy Wellness Centre
St. Albert - Grandin Clinic
St. Albert - Summit Centre
St. Albert - Sturgeon Medical Women's Imaging
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2.
How did you book your appointment?
(Required.)
Called MIC’s Central Booking phone line to book an appointment.
Used the Online Appointment Request feature on the website.
Your physician booked the examination for you.
It was a walk in x-ray examination, with no appointment required.
3.
What type of examination did you have?
Bone Densitometry
Breast Imaging - Automated Breast Ultrasound (ABUS)
Breast Imaging - Mammogram
Cardiac Studies
CT Scan
MRI
Nuclear Medicine
Pain Management
Sphenopalatine Ganglion Block
Ultrasound/MSK Ultrasound
Varicose Vein Assessment and Treatment
Whole Body Composition (DXA)
X-ray
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4.
Please rate your interaction with the following members of the MIC team:
(Required.)
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
Central Booking Staff
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
Clinic Reception Staff
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
Technologist
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
Nurse
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
5.
If you spent time with one of our radiologists, please rate your interaction
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
N/A
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6.
Please indicate your level of satisfaction with our clinic:
(Required.)
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Convenience of hours
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Appointment availability
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Amount of time spent in waiting room
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Cleanliness and comfort of waiting room
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Cleanliness and comfort of exam room
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Location
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
7.
What was your overall impression of the services provided by MIC Medical Imaging?
Excellent
Good
Neutral
Poor
Excellent
Good
Neutral
Poor
8.
Any additional comments about experience - care, quality of service etc.
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9.
Would you like to discuss your responses to this questionnaire?
(Required.)
Yes
No
10.
If you answered ‘yes’ to question #9, please provide the following information and we will contact you:
Name:
Email Address:
Daytime Phone Number:
Current Progress,
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