Element Medical Imaging - Patient Satisfaction Survey

Question Title

* 3. How promptly was your initial phone call answered by our staff?

Unacceptable (i.e., more than 2 minutes)

Slow

Average

Quickly (i.e., less than 30 seconds)

Unacceptable (i.e., more than 2 minutes)

Slow

Average

Quickly (i.e., less than 30 seconds)

Question Title

* 4. How courteous was the person who answered the phone?

Unacceptable / Rude

Did not Meet Expectations

Met expectations

Exceeded Expectations

Unacceptable / Rude

Did not Meet Expectations

Met expectations

Exceeded Expectations

Comment (please specify)

Question Title

* 5. How courteous was the person who scheduled your appointment?

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Comment (please specify)

Question Title

* 6. How long did it take to get an appointment?

Same day

One Day

2-5 days

6 days or longer

Same day

One Day

2-5 days

6 days or longer

Question Title

* 7. How courteous was the receptionist when you checked in?

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Comment (please specify)

Question Title

* 8. How quick and easy was the registration / check-in process?

Very long and/or difficult

Somewhat long and/or difficult

Normal as compared to other Healthcare providers

Somewhat quick and/or easy

Very quick and/or easy

Very long and/or difficult

Somewhat long and/or difficult

Normal as compared to other Healthcare providers

Somewhat quick and/or easy

Very quick and/or easy

Comment if necessary

Question Title

* 9. How close to your appointment time were you seen by the technologist?

Before my scheduled appointment time

Within 15 minutes of my appointment time

Longer than 15 minutes past my appointment time

Please explain if necessary

Question Title

* 10. Did the technologist introduce themselves and explain the procedure?

Yes

Question Title

* 11. How courteous was the technologist who performed your test?

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

Comment (please specify)

Question Title

* 12. Please rate your comfort and satisfaction with our exam room.

Poor

Average

Good

Excellent

Poor

Average

Good

Excellent

Comment (please specify)

Question Title

* 13. Did you speak with the Radiologist before or after your exam/procedure?

Yes

Question Title

* 14. If you did speak with the Radiologist, were you satisfied with the communication and answers to your questions?

Yes

Not applicable

If no, (please specify)

Question Title

* 15. How courteous was the Radiologist?

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

N/A

Unacceptable / Rude

Needs Improvement

Met Expectations

Exceeded Expectations

N/A

Comment (please specify)

Question Title

* 16. Did you have any privacy concerns before, during or after your visit?

Yes

If yes, please explain

Question Title

* 17. If you had any interaction with our billing company, please rate their performance. Answer N/A if you have not worked with our billing company.

	Poor	Average	Excellent	N/A
Pleasant / Polite	Pleasant / Polite Poor	Pleasant / Polite Average	Pleasant / Polite Excellent	Pleasant / Polite N/A
Promptness	Promptness Poor	Promptness Average	Promptness Excellent	Promptness N/A
Accurate resolution of your issue	Accurate resolution of your issue Poor	Accurate resolution of your issue Average	Accurate resolution of your issue Excellent	Accurate resolution of your issue N/A

Other (please specify)

Question Title

* 18. Overall, how would you rate the care you received from Element Medical Imaging?

Excellent

Very good

Good

Fair

Poor

Question Title

* 19. How likely is it that you would recommend Element Medical Imaging to a friend or colleague?

Not at all likely

Extremely likely

Question Title

* 20. Please feel free to add any other comments that you believe will help us improve our services.

Question Title

* 21. Please share your contact information so we can validate your survey.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. What procedure did you have at Element Medical Imaging?

Question Title

* 2. What was the date of your appointment?

Question Title

* 3. How promptly was your initial phone call answered by our staff?

Question Title

* 4. How courteous was the person who answered the phone?

Question Title

* 5. How courteous was the person who scheduled your appointment?

Question Title

* 6. How long did it take to get an appointment?

Question Title

* 7. How courteous was the receptionist when you checked in?

Question Title

* 8. How quick and easy was the registration / check-in process?

Question Title

* 9. How close to your appointment time were you seen by the technologist?

Question Title

* 10. Did the technologist introduce themselves and explain the procedure?

Question Title

* 11. How courteous was the technologist who performed your test?

Question Title

* 12. Please rate your comfort and satisfaction with our exam room.

Question Title

* 13. Did you speak with the Radiologist before or after your exam/procedure?

Question Title

* 14. If you did speak with the Radiologist, were you satisfied with the communication and answers to your questions?

Question Title

* 15. How courteous was the Radiologist?

Question Title

* 16. Did you have any privacy concerns before, during or after your visit?

Question Title

* 17. If you had any interaction with our billing company, please rate their performance. Answer N/A if you have not worked with our billing company.

Question Title

* 18. Overall, how would you rate the care you received from Element Medical Imaging?

Question Title

* 19. How likely is it that you would recommend Element Medical Imaging to a friend or colleague?

Question Title

* 20. Please feel free to add any other comments that you believe will help us improve our services.

Question Title

* 21. Please share your contact information so we can validate your survey.