Patient Satisfaction Questionnaire
Today's Date
Name *
Referring Doctor
Please select center location *
Appointment type (please check all that apply):
MRI   CT(cat Scan)   PET/CT
Ultrasound   X-Ray   Bone Density
Mammogram   Other    
Partners Imaging was your choice because:
1) It was on your doctors script to come to Partners
2) You live close by and the location was convenient
3) You were refferred by a patient, family or friend
4) Other reason
Please grade us on the following:
A = Excellent B = Good C = OK D = Poor
    A B C D
Ability to get an appointment  
Front office check-in process  
Quality of waiting rooms  
Explanation of exam  
Explanation of billing charges  
Timeliness from arrival to scan  
Helpfulness of technicians  
Probability you would choose Partners Imaging again  
Comments or Suggestions?
Is there someone you would like to compliment?