Draft Sample Survey - Satisfaction

Our goal is to provide prompt service and the best care possible to you and the patient. Please tell us your opinion about the service you receive at Mass General Imaging. Your response will be kept strictly confidential. Thank you for your help.

* Is the physician you work with an MGH affiliated physician?

Yes

No

* What is your office's specialty?

* Where do you refer your patients for imaging services? (check all that apply)

MGH Main Campus

MGH Chelmsford

MGH Chelsea

MGH Waltham

MGH/NS Danvers

Other Specify (i.e. Shields MRI, New England Health Imaging, etc.)

* What portion of your imaging referrals do you send to Mass General Imaging?

What are Mass General Imaging's strengths, or what does it do particularly well?

What are Mass General Imaging's weaknesses, or what would you like to see it improve?

Please rate the following:

Ability to find a timely appointment at?

Ease of scheduling an appointment on ROE (ROW ee) system?

Friendliness and courtesy of our office staff?

Exam preparation is communicated clearly to patients and understood? (i.e no eating or drinking 2 hours prior to exam)

Directions to our location are communicated clearly and understood?

Ease of insurance precertification tools and support?

Clinical support services? (i.e. Film/CD Ordering, Image Access)

Your overall satisfaction with our services?

Your overall satisfaction with our staff?

Would you recommend ____________ to your patients?

Please tell us why you would not position MGH Main Campus to your patients?

Please tell us why you would not position MGH Chelmsford to your patients?

Please tell us why you would not position MGH Chelsea to your patients?

Please tell us why you would not position MGH Waltham to your patients?