Patient Opinion Survey

Thank you for allowing us to be your MRI provider. Please fill out this questionnaire to let us know what we are doing right and what you would like us to improve upon. Your responses will be kept confidential.

Please fill out the survey below. (* Required Fields)

Scale Definition:

(1) Strongly Agree
(2) Somewhat Agree
(3) Neither Agree or Disagree

(4) Somewhat Disagree
(5) Strongly Disagree
(6) Not Applicable

1. The Center’s hours were convenient. *

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2. I was scheduled at a convenient date and time. *

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3. The scheduler was courteous and helpful. *

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4. The front desk receptionist was courteous and helpful. *

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5. The waiting area was clean and comfortable. *

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6. The time I waited to go from the waiting room to the MRI room for my exam was acceptable. *

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7. The technologist was courteous and helpful. *

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8. The billing statement was easy to read and understand. *

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9. The insurance claim filed on my behalf was accurate. *

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10. The billing staff was courteous and could be easily reached. *

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11. The billing staff was able to answer my questions and resolve my problems. *

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Would you recommend our Center to others? *

Yes No

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If not, why not?

First Name: *

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Last Name: *

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Phone Number: *

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Email Address: *

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Comments / Suggestions:

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©2011 Southwest Hospitals MRI Center, Oak Lawn, Illinois
Open MRI High Field MRI Testing Facility Located On The Southside Of Chicago