Radiology Patient Satisfaction Survey Form
Please share your feedback on your recent radiology experience to help us improve our services. Your responses are confidential and valued.
Overall, how satisfied were you with your radiology visit?
*
1
2
3
4
5
How would you rate the professionalism of the radiology staff?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The check-in process was smooth
1
2
3
4
5
I received clear instructions before my procedure
6
7
8
9
10
The waiting area was comfortable
11
12
13
14
15
Staff answered my questions clearly
16
17
18
19
20
How long did you wait before your radiology procedure began?
*
Please Select
Less than 10 minutes
10-20 minutes
21-30 minutes
More than 30 minutes
Was your privacy respected during your visit?
*
Yes
No
How likely are you to recommend our radiology services to others?
*
Not likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely, 10 is Extremely likely
Did you experience any issues during your visit?
*
No issues
Minor issues
Major issues
If you experienced issues, please describe them (optional):
What type of radiology service did you receive?
*
Please Select
X-ray
MRI
CT Scan
Ultrasound
Other
Additional comments or suggestions (optional):
Submit Survey
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