Patient Satisfaction Survey

Our goal at Sitron-Hammel Radiology is to provide the highest quality treatment in a pleasant and friendly atmosphere. Please help us ensure that we are delivering this type of service by answering this questionnaire. All information will be strictly confidential and will not be attached to your medical records.

If you are a new patient:

How did you hear about our practice?
 Physician Referral Friend/Relative Recommendation Advertisement Other

What kind of test did you have?

Scheduling this appointment:

Knowledge of the staff member scheduling your appointment.
 very satisfied satisfied neutral dissatisfied very dissatisfied

Professionalism and courtesy of the staff member.
 very satisfied satisfied neutral dissatisfied very dissatisfied

Our ability to provide you with a suitable time for your exam.
 very satisfied satisfied neutral dissatisfied very dissatisfied

Questions that you had were answered by the scheduler.
 very satisfied satisfied neutral dissatisfied very dissatisfied

During today’s visit:


The receptionist’s courtesy and efficiency
 very satisfied satisfied neutral dissatisfied very dissatisfied

The time spent in the waiting room before being called in.
 very satisfied satisfied neutral dissatisfied very dissatisfied

The professionalism and courtesy of the technologist.
 very satisfied satisfied neutral dissatisfied very dissatisfied

Sensitivity of the technologist to your needs.
 very satisfied satisfied neutral dissatisfied very dissatisfied

Any questions that you had were answered by our staff.
 very satisfied satisfied neutral dissatisfied very dissatisfied

In General:
How satisfied are you with your overall care?
 very satisfied satisfied neutral dissatisfied very dissatisfied

Would you recommend our practice to a friend or relative? Yes  No
If 'NO' why?

Comments/Suggestions: