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Mayers Memorial Hospital District

Imaging Patient Satisfaction Survey

Please tell us about your visit to the MMHD Imaging Department
  Date
  Were you able to schedule your appointment in a timely manner? Yes
No
  Was the check in process prompt and efficient? Yes
No
  Were you seen promptly when you arrived? Yes
No
  Were you saisfied with the treatment provided by the Imaging Technologist? Yes
No
  Were you informed that your referring provider would receive the results and you should follow up with your provider for diagnosis and/or treatment? Yes
No
  Did you feel your individual needs or concerns were listened to and addressed? Yes
No
  Was scheduling your appointment easy and convenient for you?
Please rate from 1 - 5 (1 being dissatisfied and 5 being satisfied)
1
2
3
4
5
  Was the Imaging Technologist professional and respectful to your privacy?
Please rate from 1 - 5 (1 being dissatisfied and 5 being satisfied)
1
2
3
4
5
  Was the comfort and cleanliness of the Imaging Department to your satisfaction?
Please rate from 1 - 5 (1 being dissatisfied and 5 being satisfied)
1
2
3
4
5
  How was the overall quality of care and service?
Please rate from 1 - 5 (1 being dissatisfied and 5 being satisfied)
1
2
3
4
5
  What did you like most about your visit?
  What could we have done better?
  Would you return to MMHD if you required medical care in the future? Yes
No
  Would you recommend MMHD to friends or family? Yes
No
  Other comments
  Can we publish your quotes? Yes
No
  Name
Optional
  Email Address