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  5. Sunshine Coast Radiology-Mar-Full Patient Survey

Sunshine Coast Radiology-Mar-Full Patient Survey

Thank you for your time. We appreciate and consider your feedbacks
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Questions marked with a * are required Exit Survey
 
 
Type of imaging service you recieved?
 
X-Ray/ Bone D/ Dental Imaging
 
Ultrasound
 
CT
 
MRI
 
Mammography
 
Nuclear Medicine
 
Other
 

 
 
 
Name of imaging staff who attended you today?
   
 
 
How did you rate the followings:
Friendliness of our reception staff
Friendliness and professionalism of our Imaging staff
Parking availability
 
 
 
Please tell us how long you waited in reception before your examination?
 
<5min
 
5-10 Min
 
10-15 Min
 
15-20 Min
 
20-30 Min
 
over 30 Min
 
 
How satisfied are you with the following:
Very DissatisfiedVery Satisfied
* Please rate your overall experience:
-
 
 
 
Comments/Suggestions:
   
Please specify how we can improve our service?
   
 
 
 
How did you hear about us?
 
GP
 
Specialist
 
Website
 
Billboard
 
Signs
 
Word of mouth
 
Magazine
 
Radio
 
TV
 
Other
 

 
 
 
Date you received imaging service?
DayMonthYear
  
 
 
 
Age Range?
 
Less than 20?
 
20 - 30
 
30 - 40
 
40 - 50
 
50 -60
 
60 - 70
 
over 80
 
 
 
Your gender
 
Female
 
Male
 
 
Thank you for your feed back

Contact Information
First Name : 
Last Name : 
Phone : 
Email Address :