Patient Feedback

Your Name (Optional)

Examination completed on the visit?
X-RayBone MineralDensityUltrasoundMammogram
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Was the clinic easy to locate?
ExcellentGoodFairNot Applicable

Were you attended to promptly and courteously upon arrival?
ExcellentGoodFairNot Applicable

Was the examination room clean and tidy?
ExcellentGoodFairNot Applicable

Was the atmosphere pleasant?
ExcellentGoodFairNot Applicable

Do you feel that your privacy was respected throughout your visit?
ExcellentGoodFairNot Applicable

Do you feel you the clinic staff treated you with respect? (Doctors, Receptionists, Technologists)
ExcellentGoodFairNot Applicable
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Were you scheduled for your appointment within 3-5 business days?
YesNoNot Applicable

Were you taken to the examination room in a reasonable amount of time?
ExcellentGoodFairNot Applicable

Would you return for another examination?
YesNoNot Applicable
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Is there a staff member you wish to recognize as giving you a positive experience?

Comments

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Daytime Contact TEL (format: 9051234567)

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