Physician Survey
Physician Name
*
First Name
Last Name
Office Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Office Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Specialty
*
Which of the following services are needed for your patients? (Check all that apply)
*
MRI
Breast MRI
CT
PET/CT
Ultrasound
X-Ray
DXA
Other
How important is evening and weekend appointment availability to your patients?
*
Extremely important
Moderately important
Slightly important
Not important at all
Overall Satisfaction with our facility:
*
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Quality of Imaging Services: How would you rate the quality of our imaging services (e.g., accuracy of reports, image quality, and equipment)?
*
Excellent
Very Good
Good
Fair
Poor
Efficiency and Wait Times: How satisfied are you with the efficiency of our services and the waiting times for appointments and reports?
*
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Communication: How would you rate our communication with you regarding results?
*
Excellent
Very Good
Good
Fair
Poor
Feedback and Suggestions: Do you have any specific feedback, suggestions, or areas where we can improve our services?
Future Needs: Are there any specific imaging services or technologies you would like to see us offer in the future?
Referral Experience: How likely are you to continue referring your patients to our imaging center?
*
Very Likely
Likely
Neutral
Unlikely
Very Unlikely
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