Patient Satisfaction Survey

Please take a moment to answer a few questions about the service you received during your recent visit.

The first 3 questions use a scale of 1 to 10, with 10 being the
highest and 1 the lowest.

1.  Please rate how friendly and professional our receptionist staff
was during your visit.


2. Please rate the facility cleanliness and how comfortable it was.

3.  Please rate how friendly and professional our technologist was during your visit.

4.  Did the technologist explain the procedure prior to your exam?

5.  Was the facility easy to find and convenient?

6.  Do you feel you had to wait a long time in the reception area?

                How long was your wait time in minutes?

7.  How was your exam scheduled?

8.  Please rate how friendly and knowledgeable the scheduler was.

9.  Did the scheduler answer all of your questions?

10.  Do you have any suggestions on how we could improve our services?

11.  Would you recommend our facility to your friends, family, and physician for future visits?

Your Name:

Your Phone:

Imaging Center that you visited:

Type of Exam:
Nuclear Medicine
Pain Management
Interventional Radiology

Date of Exam:

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