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Details

Name:

Date of Exam: *

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Location: *

New York

Facility

1 = Poor, 4 = Excellent

Cleanliness, comfort, location / access: *

1

2

3

4

Appointment scheduling

1 = Poor, 4 = Excellent

Convenience, professionalism, met your needs: *

1

2

3

4

Front desk personnel

1 = Poor, 4 = Excellent

Promptness, friendliness, appearance, knowledge: *

1

2

3

4

Employee name: *

Technologist

1 = Poor, 4 = Excellent

Promptness, friendliness, appearance, knowledge: *

1

2

3

4

Employee name: *

Modality: *

CT

MRI

X-Ray

MAM

US

DEXA

NUC

PET

Why did you choose our imaging center?: *

Convenient location

Previous visit

Advertising

Insurance referral

Physician referral

Reputation

Other

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