Patient Satisfaction Questionnaire

HOT TOPICS

OTHER INFORMATION

Serving Southwest Florida for over 35 years. Telephone: 239.936.2316

PATIENT SATISFACTION QUESTIONNAIRE

Because we wish to serve you better, we ask for your help in completing this questionnaire.

1. Your age:
2. Your sex:	Female Male
3. Name (optional):
4. Email Address:
5. Procedure:
6. Date of visit:
7. Office where services were performed:	3680 Broadway, Fort Myers 6100 Winkler Road (RPET), Fort Myers 6140 Winkler Road, Fort Myers 8200 College Parkway, Fort Myers 805 Del Prado, Cape Coral 1501 Viscaya Parkway, Cape Coral 1708 Cape Coral Parkway, Cape Coral 9776 Bonita Beach Road, Bonita Springs 700 Goodlette Road, Naples 1110 Lee Boulevard, Lehigh
8. Was this your first visit to Radiology Regional Center?	Yes No

Registration

1. When you called our office, were you scheduled courteously?	Yes No
2. Was this location convenientfor you?	Yes No
3. Were you made aware of any preparations you may need to make prior to your procedure?	Yes No
4. When you arrived, did the staff treat you courteously?	Front Reception: Yes No
	Technical Staff: Yes No
	Radiologists: Yes No
5. How long did you have to sit in the waiting area past your scheduled appointment time?
6. Do you feel this was too long for your wait?	Yes No

Tests and Procedures

1. Did we provide enough information about your procedure?	Yes No
2. If you had to complete a consent form, was it fully explained to you?	Yes No
3. Do you feel that our staff was concered about your comfort?	Yes No
Please describe your experience during or after your procedure:

Please rank the following about our office:	Above Average	Average	Below Average
Professionalism
Reception Area
Procedure Room
Cleanliness
Comfort/Temperature
Care You Received
Our Attitudes
Overall

Final Ratings

1. How did you become aware of Radiology Regional Center? (please select as many as apply)	Doctor: Newspaper: Friend/Family Referral Phone Book Television Community Event Convenient Location Radiologist/Staff Preference I'm a Long-Time Patient Other:
2. Would you recommend our office to a friend or relative?	Yes No
3. What did you like best about our office?
4. What did you like least about our office?
5.What suggestions (no matter how large or small) do you have that would help us serve you better?
6. Other comments?

Radiology Regional Center - serving the diagnostic needs of Ft. Myers, Cape Coral, Lehigh, Bonita Springs, and Naples, Florida
with X-Ray, MRI, CT, PET, Ultrasound, Mammography, Nuclear Medicine, and Health Screenings.

Website questions or problems? Email our webmaster.