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?

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* 2. What type of examination did you have?

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* 3. Please rate your interation with the following members of the MIC team:

  Very Satisfied Satisfied Dissatisfied Very Dissatisfied N/A
Central Booking Staff
Clinic Reception Staff
Technologist
Nurse

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* 4. If you spent time with one of our radiologists, please rate your interaction

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* 5. Please indicate your level of satisfaction with our clinic:

  Very Satisfied Satisfied Dissatisfied Very Dissatisfied
Convenience of hours
Appointment availability
Amount of time spent in waiting room
Cleanliness and comfort of waiting room
Cleanliness and comfort of exam room
Location

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* 6. What was your overall impression of the services provided by MIC Medical Imaging?

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* 7. Any additional comments about experience - care, quality of service etc.

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* 8. Would you be willing to be part of a patient focus group?  MIC is hoping to gain a patient perspective on the patient experience at our clinics, with the goal of identifying what is important to patients, and where we can improve. Your commitment would be a 2-4 hour session at a convenient location, with a small gift in appreciation of your time and contributions.

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* 9. Would you like to discuss your responses to this questionnaire?

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* 10. If you answered ‘yes’ to either question #8 or #9, please provide the following information and we will contact you:

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