Provider Satisfaction Survey (for Physician’s or Practicing Clinicians Only) You must have JavaScript enabled to use this form. Our goal is to provide the referring physicians with quality radiology services in a comfortable and convenient setting. We are striving to improve the service we offer and welcome your feedback and suggestions. Please take a few minutes to complete this survey about your visit. Thank you for your time and input. All comments will remain confidential. Office name (*optional): Evaluator's name (*optional): Was there a specific event that prompted you to fill out this survey? What is your position in the office? (required) Select an OptionMDPA/NPRNOffice ManagerReferral CoordinatorOther Please rate your level of satisfaction for each question below:5 = Excellent, 4 = Very Good, 3 = Good, 2 = Fair, 1 = Poor, N/A = Does Not Apply Operations Ease of getting through by phone: N/A 1 2 3 4 5 Ease of scheduling an appointment: N/A 1 2 3 4 5 Image quality: N/A 1 2 3 4 5 Report turnaround time: N/A 1 2 3 4 5 Likelihood that you will refer to our center again: N/A 1 2 3 4 5 Radiologists Report is well organized and easy to read: N/A 1 2 3 4 5 Availability for consultation: N/A 1 2 3 4 5 May we contact you for further information? Yes No E-mail: (required) What can we do to make us your first choice for your imaging needs? Other comments:
You must have JavaScript enabled to use this form. Our goal is to provide the referring physicians with quality radiology services in a comfortable and convenient setting. We are striving to improve the service we offer and welcome your feedback and suggestions. Please take a few minutes to complete this survey about your visit. Thank you for your time and input. All comments will remain confidential. Office name (*optional): Evaluator's name (*optional): Was there a specific event that prompted you to fill out this survey? What is your position in the office? (required) Select an OptionMDPA/NPRNOffice ManagerReferral CoordinatorOther Please rate your level of satisfaction for each question below:5 = Excellent, 4 = Very Good, 3 = Good, 2 = Fair, 1 = Poor, N/A = Does Not Apply Operations Ease of getting through by phone: N/A 1 2 3 4 5 Ease of scheduling an appointment: N/A 1 2 3 4 5 Image quality: N/A 1 2 3 4 5 Report turnaround time: N/A 1 2 3 4 5 Likelihood that you will refer to our center again: N/A 1 2 3 4 5 Radiologists Report is well organized and easy to read: N/A 1 2 3 4 5 Availability for consultation: N/A 1 2 3 4 5 May we contact you for further information? Yes No E-mail: (required) What can we do to make us your first choice for your imaging needs? Other comments:
