Patient Survey

In order for our site to continuously improve the quality of care provided to our patients, please take a few minutes to complete the following brief questionnaire.

Note: This survey will be submitted to us anonymously if your contact information is omitted.

Please answer the following questions by choosing the appropriate response as follows:

1 – Not Applicable
2 – Not at all satisfied
3 – Somewhat satisfied
4 – Satisfied
5 – Very satisfied
6 – Completely satisfied

  • 1) When you telephoned our office, was our staff courteous
    and friendly?
  • 2) Was the time it took for us to answer your call
    satisfactory?
  • 3) Was the time between your call to schedule an
    appointment and your appointment date satisfactory?
    (Did we fit you in fast enough?)
  • 4) When you arrived for your scheduled appointment were
    our reception area personnel courteous and helpful?
  • 5) Was our reception area comfortable and did it
    offer adequate reading/viewing materials?
  • 6) Was your exam performed in accordance with your
    scheduled appointment?
  • 7) Was the exam room clean and did it offer sufficient privacy?
  • 8) Were our technologists caring and professional?
  • 9) Was the procedure explained to you and were your questions answered?
  • 10) Was the nursing staff understanding and caring?
  • 11) Were our business office, precertification and insurance departments helpful?
  • 12) Would you recommend our facility to a family member or a friend?
  • 13) Which department you were dealing with?
  • (not required)
  • Please include contact info if you would like us to contact you.
  • (not required)
  • (not required)
  • Please comment on any aspect of your care that we may improve upon:
  • This field is for validation purposes and should be left unchanged.
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