PATIENT SATISFACTION SURVEY
If you are a new patient:
How did you hear about our practice?
Physician Referral
Friend/Relative Recommendation
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Other
What kind of test did you have?
Please give us your level of satisfaction on the following:
1=very dissatisfied 2=dissatisfied 3=neutral 4=satisfied 5=very satisfied
Scheduling this appointment:
Knowledge of the staff member scheduling your appointment
Professionalism and courtesy of the staff member.
Our ability to provide you with a suitable time for your exam.
Any questions that you had were answered by the scheduler.
During today’s visit:
The receptionist’s courtesy and efficiency.
The time spent in the waiting room before being called in.
The professionalism and courtesy of the technologist.
Sensitivity of the technologist to your needs.
Any questions that you had were answered by our staff.
In General:
How satisfied are you with your overall care?
YES
NO - Would you recommend our practice to a friend or relative?
If 'NO' why?
Comments/Suggestions:
Please click submit or send this survey to:
Marie Arcuri, R.T.
Sitron-Hammel Radiology
4277 Hempstead Tpke, Suite 200,
Bethpage, NY 11714