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Az-Tech Radiology - Patient Survey
 
 
 

Patient Survey

 

Thank you for choosing Az-Tech Radiology for your diagnostic imaging examination.

We constantly monitor the quality of our services and request that you complete this patient survey form to assist us in our evaluation.

Your assistance is greatly appreciated.

 
I had my exam performed at: ( Select a Location )
 
 
I had the following exam(s):
Bone Densitometry (DEXA)
CT Scan
General X ray
Mammogram
MRI
PET
Ultrasound
 
 
Scheduling of my exam was done by:
If other, please specify
 
 
If you scheduled your exam, please rate our service:
         
Excellent
 
Satisfactory
 
Needs Improvement
5
4
3
2
1
 
 
Preparations for my exam were explained well.
         
Excellent
 
Satisfactory
 
Needs Improvement
5
4
3
2
1
 
 
The greeting from the receptionist was professional.
         
Excellent
 
Satisfactory
 
Needs Improvement
5
4
3
2
1
 
 
If you had an appointment, did you wait past your appointment time?
Yes
No
 
If yes, how long did you wait? in minutes
 
 
If you did not have an appointment, how long did you wait?
in minutes
 
 
The technologist performing my exam explained the procedure and treated me professionally.
         
Excellent
 
Satisfactory
 
Needs Improvement
5
4
3
2
1
 
 
The appearance of the center was professional.
         
Excellent
 
Satisfactory
 
Needs Improvement
5
4
3
2
1
 
 
I would return to your center if I required this type of service in the future.
Yes
No
 
 
I heard about your centers from:
 
 
Please include additional comments of suggestions in the space below.
 
(optional)
 
Name:
Address:
Phone:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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