DPI Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.
All responses will be kept confidential.

We thank you in advance for completing this survey.

Name
Your answer
Email Address
Your answer
Phone Number
Your answer
Referring Physicians Name
Your answer
Patient Satisfaction
Please rate each of the following on a scale of 1 - 5. (1 being Poor, 5 being Great)
Scheduling of your appointment
Poor
Great
Time in waiting room
Poor
Great
Time spent at our facility
Poor
Great
Helpfulness of scheduling your appointment
Poor
Great
Friendliness/courtesy of staff at our facility
Poor
Great
Friendliness/courtesy of the technologist who performed your scan
Poor
Great
Cleanliness of the facility
Poor
Great
Location/distance of facility from you
Far
Close
Was the facility easy to find?
Difficult
Easy
Likelihood of using DPI again
Not likely
Likely
Likelihood of you recommending DPI to others
Not likely
Likely
Location of your exam
Please indicate at which location your exam was performed?
Did we provide any of the following services to you?
Please indicate what method you used to make your appointment
Do you have any other special circumstances we were or were not able to accommodate?
Your answer
What is the name of your previous diagnostic center?
Your answer
Additional Comments
What can we do better?
Your answer
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