Survey - Radiology Associates of Tallahassee

Name

First Last

Name of Technologist During Exam

Your Email Address

Name of Nurse During Exam

Complete Address

Street Address Address Line 2 City State ZIP Code

Name of Other Staff During Exam

*you may select multiple answers

Women's Imaging Center

(please specify)

Radiology Associates

(please specify)

Tallahassee Diagnostic Imaging Center

(please specify)

Please rate the following based on your experience at our facility

	Excellent	Very Good	Good	Needs Improvement	Poor
How was your scheduling experience?
How would you rate the cleanliness and comfort of this facility?
How were you greeted by the front office staff?
How would you rate the professionalism of the staff?
How was the overall service during your visit?

*select only one option per question

Did any of our employees go above and beyond to make your visit more pleasant?

What was your wait time prior to your exam?

*select only one option

Did you receive a confirmation phone call for your appointment?

*select yes OR no, and comment

Comment

If yes, did you find the information you were given helpful in preparing for your exam?

*select yes OR no, and comment

Comment

Have you seen our advertisments in any of the following areas?

*you may select multiple answers

(please specify)

What can we improve upon to make your experience better during your next exam visit?