Patient Survey

We wish to provide our patients with excellent care and service that is prompt, courteous and of the highest quality. Your responses to the following questions will assist us in our efforts to refine our services to ensure that you receive the best possible care. We encourage you to leave your contact information and we will respect your wish not to be contacted, if so desired. Radiology Associates appreciates your time and comments. Thank you!

General Information

Fields marked with an * are required

Where did you have your appointment?

What kind of exam did you have?

How did you choose our center?

Would you return to this center?

Please rate the following: (Excellent, Very Good, Good, Fair, Poor)

Was you call answered in a timely manner? (Excellent = 5 and Poor = 1)

If you called or were called to schedule over the phone, how would you rate your experience? (Excellent = 5 and Poor = 1)

Was our receptionist courteous & helpful? (Excellent = 5 and Poor = 1)

Efficiency of the check-in process & paperwork? (Excellent = 5 and Poor = 1)

Courtesy and kindness of our office staff? (Excellent = 5 and Poor = 1)

Comfort and cleanliness of the center? (Excellent = 5 and Poor = 1)

Courtesy and kindness of our technologist(s)? (Excellent = 5 and Poor = 1)

Staff gave a thorough explanation of the services and procedures? (Excellent = 5 and Poor = 1)

Overall quality of care you received? (Excellent = 5 and Poor = 1)

Likelihood that you would recommend us to a friend or relative? (Excellent = 5 and Poor = 1)

Name of Employee(s) who helped you today:

Additional Comments

We welcome your comments:

May we contact you regarding your comments?

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