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):