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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.
Sincerely,
Kevin Johnson,
V.P. of Operations
Midtown Imaging LLC.
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Please Complete ALL
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West Palm Beach |
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Palm Beach Gardens |
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Wellington/Royal Palm |
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Jupiter |
| Today's Date: |
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| Name (optional): |
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| Referred By: |
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| Appointment Type: |
| Mammogram |
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Bone Density |
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| Ultrasound |
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Xray |
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| CT |
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MRI |
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| PET Scan |
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Other |
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| 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. |
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| Availability to make an appointment (timeliness). |
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| Referral from another patient. |
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| Referral from a friend, employee or family member. |
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| Physician scheduled appointment. |
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| Participation in your medical insurance plan. |
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| other |
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| Please rate us on the following: |
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Excellent |
Good |
Fair |
Poor |
| Ability to get a timely appointment: |
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| Courtesy and helpfulness of the staff: |
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| First contact with scheduling |
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| Appearance of reception/waiting area |
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| Was the technologist friendly, knowledgeable and
helpful |
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| Explanation of treatment: |
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| Questions/Problems resolved thoroughly and timely:
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| Explanation of billing, charges, or insurance: |
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| Cleanliness of center/testing room: |
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| Were you offered directions? |
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| Was the receptionist friendly and helpful? |
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| Would you refer other patients to our center for
their diagnostic needs? |
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| From the time of your appointment, how long did
you wait to be called for your test? |
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0-5 min |
6-15 min |
16-30 min |
31-60 min |
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> 60 min |
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| Is there someone you would like to compliment? |
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| Do you have any other comments or suggestions, which
might help us to improve our service? |
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| May the clinical Director contact you in regards
to this survey? |
If Yes phone:
Email:
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