Physician Feedback Form - CVL

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Physician Feedback Form

1
How would you rate the waiting period to get an appointment for a patient exam.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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2
How long to obtain written results once your patient is seen.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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3
The facility accommodates patients when the test is urgently required for example: Rule out DVT.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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4
The interpreting physician is available to you by phone if necessary.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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5
The recommendation in the reports received are useful in patient management.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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6
The Radiologists' findings are generally consistent with your clinical findings.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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7
The reports are clear & easy to read.
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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8
Overall, how satisfied are you with this facility in the past (6) months?
Poor
Fair Good
Very Good
Excellent
No Opinion
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Poor
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Fair Good
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Very Good
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Excellent
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No Opinion
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9
* This field is required.
Full Name
Email
10
Please verify that you are human* This field is required.
11
What suggestions or changes would you recommend to improve our service?
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