MidTown Imaging

Patient Satisfaction Questionnaire:

Thank you for selecting Midtown imaging as your preferred choice for your diagnostic services. We are honored to have you as a patient in our facility and strive to exceed your expectations of patient care.

Please take a moment to share your comments with us regarding your recent visit. We appreciate your feedback and look forward to exceeding your expectations in the future.

Please Complete ALL fields

Today's Date:

Name (optional):

Site Name:

Appointment Type:

Mammogram

Bone Density

Ultrasound

Xray

CT

MRI

PET Scan

Other

Which of the following influenced your decision to make an appointment with us? (if more than one reason, please rank in order of importance, with 1 being of highest importance and 10 being the lowest).

Proximity to home or office.

Availability to make an appointment (timeliness).

Referral from another patient.

Referral from a friend, employee or family member.

Physician scheduled appointment.

Participation in your medical insurance plan.

other

Please rate us on the following:

Excellent

Good

Fair

Poor

Ability to get a timely appointment:

Courtesy and helpfulness of the staff:

First contact with scheduling

Appearance of reception/waiting area

Was the technologist friendly, knowledgeable and helpful

Explanation of treatment:

Questions/Problems resolved thoroughly and timely:

Explanation of billing, charges, or insurance:

Cleanliness of center/testing room:

Were you offered directions?

Was the receptionist friendly and helpful?

Would you refer other patients to our center for their diagnostic needs?

From the time of your appointment, how long did you wait to be called for your test?

0-5 min

6-15 min

16-30 min

31-60 min

> 60 min

Is there someone you would like to compliment?

Do you have any other comments or suggestions, which might help us to improve our service?

May the clinical Director contact you in regards to this survey?

If Yes phone:
Email: