Patient Satisfaction Survey

We value all patient feedback and appreciate the time taken to complete this survey. The information you provide will be treated as strictly confidential and will be used by us only to improve our service.

Question Title

* 1. What Affidea clinic did you attend?

Mallow

Dublin City Centre [Meath]

Cork

Dundrum

Kilkenny

Naas

Northwood

Sligo

Letterkenny

Other (please specify)

Question Title

* 2. What type of scan did you have at Affidea?

MRI

Ultrasound

DXA (Bone density)

X-ray

OPG (Dental)

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* 3. When did your scan take place?

Enter date

Date

Question Title

* 4. How did you cover the cost of the scan?

VHI

Laya Healthcare

Irish Life [Formally Aviva]

Garda Medical Aid

Glo Health

ESB

Self-financed

Medical Card

Prison Officers Cover

Unknown

None of the above, please fill in other

Other (please specify)

Question Title

* 5. Please rate our service according to the following:

	Excellent	Very Good	Good	Average	Poor
Making the appointment	Making the appointment Excellent	Making the appointment Very Good	Making the appointment Good	Making the appointment Average	Making the appointment Poor
Waiting time in clinic	Waiting time in clinic Excellent	Waiting time in clinic Very Good	Waiting time in clinic Good	Waiting time in clinic Average	Waiting time in clinic Poor
Comfort and cleanliness of the clinic	Comfort and cleanliness of the clinic Excellent	Comfort and cleanliness of the clinic Very Good	Comfort and cleanliness of the clinic Good	Comfort and cleanliness of the clinic Average	Comfort and cleanliness of the clinic Poor
Staff friendliness, sensitivity and professionalism	Staff friendliness, sensitivity and professionalism Excellent	Staff friendliness, sensitivity and professionalism Very Good	Staff friendliness, sensitivity and professionalism Good	Staff friendliness, sensitivity and professionalism Average	Staff friendliness, sensitivity and professionalism Poor
Information on what to do next	Information on what to do next Excellent	Information on what to do next Very Good	Information on what to do next Good	Information on what to do next Average	Information on what to do next Poor
Level of hand hygiene observed	Level of hand hygiene observed Excellent	Level of hand hygiene observed Very Good	Level of hand hygiene observed Good	Level of hand hygiene observed Average	Level of hand hygiene observed Poor

Further comments

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* 6. It is our Policy to ensure that the patients are identified correctly, did the Radiographer ask for your name and date of birth prior to the radiology examination ?.

Yes

Don't remember

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* 7. Are there any comments that you would like to make in order to improve our services?

Yes

If 'yes' please describe here

Question Title

* 8. Thank you for taking the time to complete this survey. If you would like Affidea Ireland to follow-up with you with regards to your feedback please enter your name, email address and/or phone number below.

If your comment relates to the content of your radiology report, your referring physician needs to contact Affidea on the phone number supplied on the report.

Name:

Email Address:

Phone Number: