Patient Survey - RAI

Patient Survey

HomePatient Survey

1. When calling our office to make an appointment, how were you treated by our patient care coordinators?

*Please select one.

2. Time between making an appointment and being seen?

*Please select one.

3. Reception staff at check-in were friendly and courteous?

*Please select one.

4. Procedure performed was explained by the technologist?

*Please select one.

5. Length of time in reception area?

*Please select one.

6. Was the technologist sensitive of your needs?

*Please select one.

7. How satisfied are you with the overall care you received when you visited our office?

*Please select one.

8. For this appointment which RAI location did you visit?

*Please select one.

9. Date of Visit/Service

Please select the date you visited our office

10. Any additional comments you would like to make about our facility and/or staff?

*Comments

11. *Your Name

12. Would you like a Supervisor to contact you?

*Please select one.

13. If yes, please provide phone number and/or email address

Email
Phone