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1. What site was your exam at?




2. What exam did you have?



3. What type of patient were you?



4. The hours of operation of our department were convenient for me.
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5. I was able to schedule an appointment at a time convenient for me.
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6. I received an appointment as soon as I wanted.
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7. What length of time (in minutes) did you wait before a staff member approached you to start your test/procedure?
No Wait Less than 15 15-30 30 or more


8. The waiting time was acceptable to me.
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9. If your wait was longer than 15 minutes, were you notified of the delay?
Yes No


10. Please rate your experience during this visit with the receptionist with whom you interacted:
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11. Please rate your experience during this visit with the technical person with whom you interacted:
Poor Fair Good Excellent


12. Those who cared for me demonstrated genuine caring and compassion.
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13. Did the staff explain the test/proceedure in a way you could understand?
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14. Overall, how would you rate this visit?
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15. Would you recommend this facility to your family and friends?
Definitely No Probably No Probably Yes Definitely Yes


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