Advanced Medical Imaging, Denver Colorado
Referring Office Survey
This questionnaire is designed to assess the quality of Advanced Medical Imaging's radiology
services. We would appreciate your comments, both positive and negative, which will
help us in our continuing efforts to assure the highest quality of diagnostic services.


*** Please complete all questions before submitting ***
Clerical Services (including front desk and transcription personnel)
No Opinion
N/A
Very Disappointed Somewhat Disappointed Somewhat Satisfied Very Satisfied
Transcription of Reports 
Availability/Timeliness of Reports  
Procedure Scheduling  
Phone 'Hospitality'  
Cooperation with Your Office Staff  
Interaction with Patients  
Comments

Technologists
No Opinion
N/A
Very Disappointed Somewhat Disappointed Somewhat Satisfied Very Satisfied
Quality of Images  
Cooperation with Referring Physicians  
Interaction with Patients  
Timeliness in Completion of Exams  
Procedure Scheduling  
Phone 'Hospitality'  
Comments

Radiologists
No Opinion
N/A
Very Disappointed Somewhat Disappointed Somewhat Satisfied Very Satisfied
Quality/Accuracy of Reports  
Days/Hours of Radiologist Coverage  
Availability for Consulation  
Cooperation with Medical Staff  
Interaction with Patients  
Comments

Overall Services
No Opinion
N/A
Very Disappointed Somewhat Disappointed Somewhat Satisfied Very Satisfied
Availability of Films/CDs  
Staffing  
Patient Wait Time  
Response to Your Complaints (if no complaints, mark N/A)  
Frequency of Patient Complaints  
Billing Explanations  
Film Loan Policies  
Film Copy Policies  
Comments

Office:    
Name (Optional):