Patient and Family Feedback

Medical Imaging, Cardio-Respiratory

and Neuro Diagnostic Services

Medical Imaging, Cardio-Respiratory and Neuro Diagnostic Services strive to meet the needs of our patients and their families. We wish to partner with our patients and families, and are learning to see our services through their eyes. Please complete this survey to help us make your experience the best it can be.

Thank you for your participation in this survey - we appreciate the time you are investing!

Question Title

* 1. Please rate our services

	Excellent	Good	Average	Poor	Very Poor
1. Booking of your test	1. Booking of your test Excellent	1. Booking of your test Good	1. Booking of your test Average	1. Booking of your test Poor	1. Booking of your test Very Poor
2. Check-in in and registration process	2. Check-in in and registration process Excellent	2. Check-in in and registration process Good	2. Check-in in and registration process Average	2. Check-in in and registration process Poor	2. Check-in in and registration process Very Poor
3. Ease of finding the department	3. Ease of finding the department Excellent	3. Ease of finding the department Good	3. Ease of finding the department Average	3. Ease of finding the department Poor	3. Ease of finding the department Very Poor
4. Questions and concerns answered	4. Questions and concerns answered Excellent	4. Questions and concerns answered Good	4. Questions and concerns answered Average	4. Questions and concerns answered Poor	4. Questions and concerns answered Very Poor
5. Staff politeness/courtesy	5. Staff politeness/courtesy Excellent	5. Staff politeness/courtesy Good	5. Staff politeness/courtesy Average	5. Staff politeness/courtesy Poor	5. Staff politeness/courtesy Very Poor
6. Post exam instructions	6. Post exam instructions Excellent	6. Post exam instructions Good	6. Post exam instructions Average	6. Post exam instructions Poor	6. Post exam instructions Very Poor
7. Cleanliness and comfort	7. Cleanliness and comfort Excellent	7. Cleanliness and comfort Good	7. Cleanliness and comfort Average	7. Cleanliness and comfort Poor	7. Cleanliness and comfort Very Poor
8. Overall experience	8. Overall experience Excellent	8. Overall experience Good	8. Overall experience Average	8. Overall experience Poor	8. Overall experience Very Poor

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* 2. Would you recommend our services to a friend or relative?

1. Yes

2. No

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* 3. How can we improve the services we offer, or your experience?

Question Title

* 4. If you would like to share your experience in Medical Imaging, Cardio-Respiratory or Neurology Services please provide us with your name and contact information.