Patient Satisfactory Survey

Our goal is to provide the highest quality treatment in a pleasant and friendly atmosphere. Please help us ensure that we are delivering this type of service by answering this questionnaire. All information will be strictly confidential and will not be attached to your medical records.
Which Zwanger-Pesiri location did you visit?

Which study (studies) were you here for?

Please rate how professional, helpful, friendly and courteous our staff was.

  Excellent Good Fair Poor
Telephone Scheduling Staff
Front Desk Registration Staff
Technologists
Nurse (if applicable)
Radiologist (if applicable)
In general, did you feel the staff presented themselves in a professional and competent manner?
How would you rate the appearance and cleanliness of our office?
Overall, how would you rate your experience at Zwanger-Pesiri?

 

 

 

 
Was your appointment on the day/time you desired? Yes No
After registration, how long were you waiting prior to your study?

How did you initially hear of Zwanger-Pesiri?

What made you choose Zwanger-Pesiri?
Is there any staff member(s) who you feel deserves special commendation?
Please elaborate on any staff member(s) you feel needs improvement.
Do you have any other suggestions for our overall improvement? 
Would you recommend us? No
Additional comments/questions

 

Name (optional) Date

Email (optional)

 

We would like to thank you.  Your assistance is greatly appreciated!

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