Thank you for your time. We appreciate and consider your feedbacks
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Questions marked with a * are required Exit Survey
 
 
Type of imaging service you recieved?
 
X-Ray
 
Ultrasound
 
CT
 
MRI
 
Mammography
 
Nuclear Medicine
 
Bone Mineral Density
 
Interventional procedures
 
Dental Imaging
 
Other
    

 
 
 
Name of imaging staff who attended you today?
   
 
 
 
Location (Please select)
 
 
 
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
How would you rate our booking service?
-
 
 
 
Comments:
   
 
 
 
Please tell us how long you waited in reception before your examination?
 
<5min
 
5-10 Min
 
10-15 Min
 
15-20 Min
 
20-30 Min
 
over 30 Min
 
 
How satisfied are you with the following:
Very DissatisfiedVery Satisfied
0 100
Please rate your overall experience: *
-
 
 
 
Comments/Suggestions:
   
Please specify how we can improve our service?
   
 
 
 
How did you hear about us?
 
GP
 
Specialist
 
Website
 
Billboard
 
Signs
 
Word of mouth
 
Magazine
 
Radio
 
TV
 
Other
    

 
 
 
Date you received imaging service?
MonthDayYear
  
 
 
 
Age Range?
 
Less than 20?
 
20 - 30
 
30 - 40
 
40 - 50
 
50 -60
 
60 - 70
 
over 80
 
 
 
Your gender
 
Female
 
Male