Patient Survey We welcome patient feedback to assist us in monitoring the quality of our service. Please take a few minutes to provide us with important information to assist us in our effort to better serve you. NameDate of Visit MM DD YYYY Examination performedUltrasoundX-rayBMDWas it easy to book an initial appointment?YesNoDid you have any difficulty finding the clinic?YesNoDid you receive a reminder call about your appointment?YesNoDid you receive proper preparation instructions for your exam today?YesNoWere you greeted courteously when you arrived in the clinic?YesNoWere you taken to the examination room in a reasonable length of time?YesNoWere your questions answered satisfactorily?YesNoWere you treated with courtesy and respect during the examination?YesNoWas your privacy respected during your visit?YesNoDid you find the atmosphere of the clinic pleasant?YesNoWould you recommend this clinic to your family and friends?YesNoComments/Suggestions for ImprovementCAPTCHANameThis field is for validation purposes and should be left unchanged.