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CDC CLINICIAN SATISFACTION SURVEY
Thank you for your confidence in us. So that we can continue to meet the needs of our referring physicians/staff, please complete the following survey about how you experienced our practice service and communication. All responses will be kept confidential.
Your Office Name - Please enter the name of your office or medical practice.
Your Role - What is your position in the office?
Physician
PA / NP
RN
Office Manager
Referral Coordinator
Other
OPERATIONS
Operations - Please rate us on the following using a scale of 1-4
1 - Poor
2 - Average
3 - Good
4 - Excellent
Not Applicable
Ease of getting through by phone
Ease of scheduling an appointment
Friendliness of staff
Image quality
Report turnaround time
Access to images/reports online
Operations Comments?
RADIOLOGISTS
Radiologists - Please rate us on the following using a scale of 1-4
1 - Poor
2 - Average
3 - Good
4 - Excellent
Not Applicable
Accuracy / Quality of reports
Radiologist availability for consultation
Radiologists Comments?
PATIENT EXPERIENCE FEEDBACK
Patient Experience Feedback - Please rate us on the following using a scale of 1-4
1 - Poor
2 - Average
3 - Good
4 - Excellent
Not Applicable
Customer Service
Cleanliness of our imaging center
Location / Access to our imaging center
Patient Experience Comments?
OVERALL
Overall Satisfaction - Please rate us on the following using a scale of 1-4
1 - Poor
2 - Average
3 - Good
4 - Excellent
Not Applicable
How well do we anticipate your needs
Likelihood you will refer to our imaging center again
Our service favorably differentiates us from other imaging providers
Overall Experience Comments?
Additional Comments? (Optional) - What is most memorable about our service? What one thing could we do to enhance our service to your practice? Other comments?
