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Patient Satisfaction Survey
Please rate your experience with Radiology Associates
Courteous and helpful reception area personnel
---Please Select---
Excellent
Very Good
Good
Fair
Poor
n/a
Length of time waiting for exam / procedure
---Please Select---
Excellent
Very Good
Good
Fair
Poor
n/a
Caring and professional technologist
---Please Select---
Excellent
Very Good
Good
Fair
Poor
n/a
Questions answered and procedure(s) explained
---Please Select---
Excellent
Very Good
Good
Fair
Poor
n/a
Overall medical care provided by Radiology Associates?
---Please Select---
Excellent
Very Good
Good
Fair
Poor
n/a
What can we do to make your experience more pleasant?
How did you hear about Radiology Associates?
---Please Select---
Physician Referral
Friend
Repeat Customer
Website
Would you recommend Radiology Associates to a family member or friend?
---Please Select---
Yes
No
My exam/procedure was performed at:
---Please Select---
St. Francis Medical Center (Downtown)
St. Francis Medical Center (North)
Monroe Surgical
Kitty Degree Breast Health Center
The name of my exam/procedure was:
---Please Select---
CT
MRI
Mammogram
Nuclear Medicine
PET/CT
Ultrasound
X-Ray
Multiple Exams
Date of visit:
Patient's name (optional)
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