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* 2. What is the name of the study you received today?

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* 3. Scheduling: Did you schedule your appointment?

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* 4. Please indicate your level of satisfaction:

  Very Satisfied (5) Satisfied (4) Unsatisfied (3) Extremely Unsatisfied (2) No Opinion (1)
SCHEDULING
1. Your ability to schedule an appointment that was convenient
2. The adequacy of the instructions about how to prepare for your exam
3. The courtesy and efficiency of the scheduling staff
4. Your overall level of satisfaction with the scheduling process
REGISTRATION
1. The courtesy and efficiency of the receptionist
2. The comfort and appearance of the waiting room
3. Your overall level of satisfaction with the registation process
YOUR PROCEDURE
5. The technologist's sensitivity and ability to communicate
6. Thoroughness in explaining the procedure
7. Respect for your privacy
8. The comfort and appearance of the exam room
9. Your overall level of satisfaction with your procedure

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* 5. Your Procedure: Did you have an appointment?

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* 6. Your Procedure: Did you have to wait past your scheduled appointment time?

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* 7. Your Procedure: Approximately How Long Was Your Wait?

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* 8. Your Procedure: Would you recommend Fairfax Radiological Consultants to a friend or relative?

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* 9. We would appreciate additional comments:

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* 10. Date of Contact (if received by telephone, or social media)

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* 11. Patient Name (optional)

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* 12. Internal Action Taken

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* 13. At what email address would you like to be contacted?

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