Imaging Services Patient Satisfaction Survey Thank you for completing this survey about your experience with the Imaging Services department at Bermuda Hospitals Board. Your feedback is important to us and will help us improve the quality of our services. Question Title * 1. I am: the patient responding on behalf of the patient (eg guardian/caregiver) Other (please specify) Question Title * 2. Date of your appointment Enter the date of your appointment as DD/MM/YYYY Date Question Title * 3. Did you receive your appointment information within two days of your doctor's request? Yes No Does not apply Question Title * 4. How long was it between the date of your doctor's request and your appointment date? 1 week or less Between 1 week and 2 weeks More than 2 weeks but less than 3 weeks 3 weeks or more Does not apply Question Title * 5. How easy or difficult was it to schedule your appointment? Very easy Easy Neither easy nor difficult Difficult Very difficult Does not apply Your comments Question Title * 6. Were the staff professional? Extremely professional Very professional Somewhat professional Not very professional Not at all professional Your comments Question Title * 7. Were the staff responsive to your needs? Extremely responsive Very responsive Somewhat responsive Not very responsive Not at all responsive Does not apply Your comments Question Title * 8. Were the staff prepared and ready for you when your test began? Very prepared Somewhat prepared Not very prepared Your comments Question Title * 9. Was the correct test performed based on your doctor's request? Yes No Don't know/not sure Question Title * 10. Overall, how satisfied were you with your experience? Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Question Title * 11. What was good about your experience? Question Title * 12. What could have been improved? It would help us to know a little about you. Although this section is optional, it helps us to better understand if different groups of people have different experiences with us. You will not be identified by any of the information provided. Question Title * 13. What is your gender? Female Male Other (please specify) Prefer not to answer Question Title * 14. What is your age? 0-7 8-11 12-15 16-24 25-34 35-44 45-54 55-64 65-74 75 or older Question Title * 15. Do you consider yourself to have a disability? Yes No Question Title * 16. I am: a Bermudian resident a non-Bermudian resident a visitor Other (please specify) I prefer not to answer Question Title * 17. As part of this survey, it may be helpful for us to collect more information about your experience. Would you be willing for BHB to contact you? If yes, please provide your contact information. Name Email Address Phone Number Done