Referring Physician Satisfaction Survey

CLERICAL SERVICES

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Courtesy and helpfulness of office staff
Calling to make an appointment
Phone answered promptly and hold time is minimal
Timely response to voice mail messages
Level of knowledge/courtesy of our front desk employees
Front desk interaction with your patients

REPORTS

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Delivery of Report (faxed / electronically downloaded)

QUALITY OF PROFESSIONAL READINGS (REPORTS)

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied	NA
CT Scanning
Ultrasound
X-Ray
Mammography (Camberwell Only)

QUALITY OF IMAGES

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied	NA
CT Scanning
Ultrasound
X-Ray
Mammography (Camberwell Only)

TECHNICAL SERVICES

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Level of professionalism / knowledge of technical staff
Feedback for patients about technologists

OVERALL SERVICES

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Selection of appointment times
Availability of urgent appointments
Days/Hours of service
Patient wait time
Level of knowledge/courtesy of billing staff
Feedback from patients about office staff

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
OVERALL EXPERIENCE

Any comments:
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NEEDS ASSESSMENT
Please rate the importance of the following to you:

	Not Important	Slightly Important	Important	Very Important	Essential
Reputation of x-ray faculty
Accessibility of Radiologists
Office visits from marketing/company representative
Quality of diagnostic equipment
Travel distance for patient
Availability of parking
Availability of urgent and/or same day appointments
Access to images and/or reports online
Informative Radiology newsletter
CPD accredited Information Evenings

Who typically schedules imaging services for your office?
Patient,
Physician,
Office Staff

If you were not aware we provide the following services, please check:
Calcium Scoring and Coronary CT Angiography,
Electronically Downloaded Reports
Fine Needle Aspirations and Ultrasound guied cortisone injections

In your own words, feel free to share your past experience in dealing with MSI?
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How can our services be improved?
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PROFESSIONAL DEVELOPMENT
Is there an area of radiology and/or procedure/modality that you would like more information about?
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Name

Your Medical Speciality

Phone

SurveyBob

Referring Physician Satisfaction Survey