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Patient Satisfaction Survey

CLERICAL STAFF

	Strongly Agree	Agree	Disagree	Stongly Disagree
The scheduling staff were pleasant and professional
The reception staff were pleasant, professional and efficient

Who made your appointment?
I did
My doctor's office did
I did not have an appointment

How long did you wait before the procedure?

The wait was ....
Okay
Too long

What time of the day did you visit us?
Morning
Afternoon

What type of examination did you have?
Ultrasound
X-ray
CT Scan
OPG
Mammogram

THE TECHNOLOGIST

	Strongly Agree	Agree	Disagree	Stongly Disagree
Professional
Thorough
Knowledgeable
Explained my exam to my satisfaction

How did you hear about us?
My Doctor
Friend/Family Member
Insurance Plan
Internet
Other

Based on my experience. I am pleased with the care I recived while at MSI:
1 (Disappointing)
2
3
4
5 (Outstanding)

Have you visited other radiology offices in the past?
Yes
No

If Yes, Which ones?

If yes, how did today's experience compare to your visit elsewhere?
Much better today
better today
about the same
worse today

Why was today's visit better or worse?
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Please share your comments with us:
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Name:

Year you were born:

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