Patient Satisfaction Survey

Thank you for visiting Delaney Radiology. We know that we are not the most fun place to be, but we appreciate you choosing us when you need expert care and service. We want to hear your feedback so we can keep improving. Please fill out this quick survey and let us know your thoughts. Your answers will be kept anonymous. Thank you for your time in providing your feedback.

1. How much do you agree with the following statements regarding your experience with Delaney Radiology? Please check the best answer in the column for each row.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
Scheduling my appointment was quick and easy.
The check-in process was quick and easy.
My technologist was friendly and helpful during my appointment.
The facility was clean and comfortable.
The billing and payment process was smooth and convenient.
I would recommend Delaney Radiology to a friend or family member.

2. Please detail any additional information about your experience that you would like to share. (optional)

3. Please provide a short review of your experience with Delaney Radiology. Your review will be kept confidential. The next questions will give us permission to use the review for marketing purposes. (optional)

4. Does Delaney Radiology have permission to use your review for marketing purposes?(Required)

Yes

Please check only one response.

Please provide your name and email address as an okay for Delaney Radiology to use your written review as part of our marketing tools. Your name will NOT be used in any public forums. Please write N/A in the required fields if we do NOT have permission to use this review.

First Name(Required)

Last Name(Required)

Email(Required)

Comments

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