Patient Satisfaction Survey

Please tell us your opinion about the service you received from Valley Medical Imaging. Your responses will be kept strictly confidential.
Your feedback is appreciated.

PLEASE RATE THE FOLLOWING:

A. YOUR APPOINTMENT	Excellent	Very Good	Good	Fair	Poor	Does not apply
1. Ease of making appointments by phone	5	4	3	2	1	N/A
2. Appointment available within a reasonable amount of time	5	4	3	2	1	N/A
3. Exam completed in a timely manner	5	4	3	2	1	N/A
4. The efficiency of the check-in process	5	4	3	2	1	N/A
5. Waiting time in the reception area	5	4	3	2	1	N/A
6. Waiting time in the exam room	5	4	3	2	1	N/A

B. OUR STAFF	Excellent	Very Good	Good	Fair	Poor	Does not apply
1. The courtesy of the person who took your call	5	4	3	2	1	N/A
2. The friendliness and courtesy of the receptionist	5	4	3	2	1	N/A
3. The caring and concern of our technologists	5	4	3	2	1	N/A
4. The professionalism of our staff	5	4	3	2	1	N/A

C. OUR COMMUNICATION WITH YOU	Excellent	Very Good	Good	Fair	Poor	Does not apply
1. Your phone calls answered promptly	5	4	3	2	1	N/A
2. Getting advice or help when needed during office hours	5	4	3	2	1	N/A
3. Explanation of your procedure (if applicable)	5	4	3	2	1	N/A
4. Effectiveness of our communications via website	5	4	3	2	1	N/A

D. OUR FACILITY	Excellent	Very Good	Good	Fair	Poor	Does not apply
1. Overall comfort	5	4	3	2	1	N/A
2. Cleanliness	5	4	3	2	1	N/A
3. Adequate parking	5	4	3	2	1	N/A
4. Signage and directions easy to follow	5	4	3	2	1	N/A

E. YOUR OVERALL SATISFACTION WITH	Excellent	Very Good	Good	Fair	Poor	Does not apply
1. Our clinic	5	4	3	2	1	N/A
2. The quality of your medical care	5	4	3	2	1	N/A

WOULD YOU RECOMMEND US TO OTHERS?

Yes No

IF NO, PLEASE EXPLAIN WHY:

IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT:

This survey is confidential unless you request otherwise. Would you like a phone call about your experience?
If so please enter your name and number:

SOME INFORMATION ABOUT YOU:

Which of our clinics did you visit? Abbotsford Langley Chilliwack

What was the purpose of your visit? X-Ray Mammography Ultrasound

Please answer 4+3=

Thank you very much for your help!