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. OK Question Title * 1. Which clinic did you visit? Allin Clinic Century Park College Plaza Gateway Hys Centre Namao 160 Tawa Centre Terra Losa Windermere Fort Saskatchewan - South Pointe Sherwood Park - Synergy Wellness Centre St. Albert - Grandin Clinic St. Albert Summit Centre OK Question Title * 2. What type of examination did you have? Bone Densitometry Breast Imaging - Automated Breast Ultrasound (ABUS) Breast Imaging - Mammogram Cardiac Studies CT Scan Gastrointestinal Imaging MRI Nuclear Medicine Pain Management Sphenopalatine Ganglion Block Ultrasound/MSK Ultrasound Varicose Vein Assessment and Treatment Whole Body Composition (DXA) X-ray OK Question Title * 3. Please rate your interation with the following members of the MIC team: Very Satisfied Satisfied Dissatisfied Very Dissatisfied N/A Central Booking Staff Central Booking Staff Very Satisfied Central Booking Staff Satisfied Central Booking Staff Dissatisfied Central Booking Staff Very Dissatisfied Central Booking Staff N/A Clinic Reception Staff Clinic Reception Staff Very Satisfied Clinic Reception Staff Satisfied Clinic Reception Staff Dissatisfied Clinic Reception Staff Very Dissatisfied Clinic Reception Staff N/A Technologist Technologist Very Satisfied Technologist Satisfied Technologist Dissatisfied Technologist Very Dissatisfied Technologist N/A Nurse Nurse Very Satisfied Nurse Satisfied Nurse Dissatisfied Nurse Very Dissatisfied Nurse N/A OK Question Title * 4. 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 OK Question Title * 5. Please indicate your level of satisfaction with our clinic: Very Satisfied Satisfied Dissatisfied Very Dissatisfied Convenience of hours Convenience of hours Very Satisfied Convenience of hours Satisfied Convenience of hours Dissatisfied Convenience of hours Very Dissatisfied Appointment availability Appointment availability Very Satisfied Appointment availability Satisfied Appointment availability Dissatisfied Appointment availability Very Dissatisfied Amount of time spent in waiting room Amount of time spent in waiting room Very Satisfied Amount of time spent in waiting room Satisfied Amount of time spent in waiting room Dissatisfied Amount of time spent in waiting room Very Dissatisfied Cleanliness and comfort of waiting room Cleanliness and comfort of waiting room Very Satisfied Cleanliness and comfort of waiting room Satisfied Cleanliness and comfort of waiting room Dissatisfied Cleanliness and comfort of waiting room Very Dissatisfied Cleanliness and comfort of exam room Cleanliness and comfort of exam room Very Satisfied Cleanliness and comfort of exam room Satisfied Cleanliness and comfort of exam room Dissatisfied Cleanliness and comfort of exam room Very Dissatisfied Location Location Very Satisfied Location Satisfied Location Dissatisfied Location Very Dissatisfied OK Question Title * 6. What was your overall impression of the services provided by MIC Medical Imaging? Excellent Good Neutral Poor Excellent Good Neutral Poor OK Question Title * 7. Any additional comments about experience - care, quality of service etc. OK Question Title * 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. Yes No OK Question Title * 9. Would you like to discuss your responses to this questionnaire? Yes No OK Question Title * 10. If you answered ‘yes’ to either question #8 or #9, please provide the following information and we will contact you: Name: Email Address: Daytime Phone Number: OK DONE
