Healthcare Provider Service Satisfaction Survey

This questionnaire is designed to assess the quality of radiology services provided to you. Your input is highly valued as it provides an opportunity for us to address areas of concern in ways that are responsive to the needs of your practice. Please click on the rating that best describes your satisfaction level.

	1 Very Dissatisfied	2 Somewhat Dissatisfied	3 Somewhat Satisfied	4 Very Satisfied	5 No Opinion
1. REPORT QUALITY & TURNAROUND
Quick & Accurate Report Turnaround
Wet Reads When Requested

2. TELEPHONE RESPONSIVENESS
Efficiency of Automated Prompts
Courteous & Professional Response
Time Placed On-Hold

3. SCHEDULING EFFECTIVENESS
Timely & Convenient Appointments
Ability to Fit in Urgent Cases
Efficiency of Scheduling Process

	1 Very Dissatisfied	2 Somewhat Dissatisfied	3 Somewhat Satisfied	4 Very Satisfied	5 No Opinion
4. QUALITY OF STUDIES
MRI
CT (Cat Scan)
Fluoroscopy (GI)
GU (IVP)
General Diagnostic X-ray
Ultrasound
Nuclear Medicine
DEXA Bone Densitometry
Breast Imaging (Mammography)
Special Procedures

5. RADIOLOGISTS
Responsiveness/Availability for consultation
Interaction with patients

	1 Very Dissatisfied	2 Somewhat Dissatisfied	3 Somewhat Satisfied	4 Very Satisfied	5 No Opinion
6. TECHNOLOGISTS & SUPPORT STAFF
Courtesy, helpfulness & professionalism

7. PHYSICAL FACILITIES
Location Convenience
Parking Convenience
Cleanliness
Atmosphere and Decor

Would you recommend DRCMRI to a colleague?

yes

Do you have any recommendations for us?

Would you like us to contact you?

yes

Name (optional):
Phone Number:

Thank you!

Radiologists Dr. David Chun, M.D., Dr. Peter Doss , M.D., Dr. Leo Fontana, M.D., Dr. Edward Rittweger, M.D.,
Dr. Charles Saniewski, M.D., Dr. Mark Singer, M.D., and Dr. David G. Wirtshafter, M.D.,
serving Avenel, Woodbridge, Colonia, Carteret, Fords, Perth Amboy, Iselin, Sewaren, Edison, Metuchen, Keasbey, Clark,
Port Reading, Rahway, Menlo Park, Linden, Piscataway, South Plainfield, Westfield, Cranford and the surrounding area.

Doctors Radiology Center and MRI of Woodbridge | 1500 St. Georges Avenue | Avenel, NJ 07001 | Tel: 866-372-1965

www.drcmri.com