Meeting Your Needs Before Your Visit

1. What study (or studies) did you have performed at the Radiology Group Imaging Center most recently? (Select as many as necessary)

2. Why did you choose to have your exam performed at the Radiology Group Imaging Center?

3. If you answered "B,""C," or "D" in the previous question, please specify why you chose to come to the Radiology Group Imaging Center:

4. Who scheduled your appointment?

5. If you answered "B" to the previous question please indicate how strongly you agree with the following statements:

Meeting Your Needs During Your Visit

6. When I arrived, the Receptionist . . .

7. Do you recall the receptionist's name who checked you in? If so, and if you would like to do so, please enter their name here.

8. If your exam REQUIRED an appointment, how soon was your exam (or exam prep) started compared to your scheduled appointment time?

9. If your exam DID NOT REQUIRE an appointment, how long did you wait in the waiting room after checking in?

10. The technologist:

11. Do you recall the technologist's name that performed your exam? If so, and if you would like to do so, please enter their name here.

12. Please indicate how strongly you agree with the following statements:

Your Thoughts After Your Visit

13. If you needed another imaging exam, would you ask your physician to send you to the Radiology Group Imaging Center?

14. Would you recommend Radiology Group Imaging Center to others?

15. Please feel free to comment on your previous answer in this space.

16. Was there a particular staff member who made your visit more pleasant? If so, and if you wish to do so, please tell us who that person was and what did they do to make it more pleasant?

17. Which service statement do you associate with the Radiology Group Imaging Center:

18. How can we improve our service to you? (If you need additional space, please email your comments to: KDFlick@rgimaging.com )

19. Would you like an imaging center representative to contact you about your concerns? (If you answer "Yes" please be sure to provide us with your contact information below.)