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Patient Satisfaction Survey
Our goal is to provide the highest quality treatment in a pleasant and friendly atmosphere. Please help us ensure that we are delivering this type of service by answering this questionnaire. All information will be strictly confidential and will not be attached to your medical records.
Your Name
Which Zwanger-Pesiri location did you visit?
---- Select an Office -----
Merrick
Massapequa
Plainview
Lindenhurst
West Islip
Smithtown
Stony Brook
East Setauket
Medford
Which study (studwhies) were you here for?
---- Please select study-----
PET/CT Scan
Nuclear Medicine
MRI/MRA
CT Scan
Digital X-Ray
Fluoroscopy
Mammogram
BSGI Scan
PEM Scan
Ultrasound
Bone Density
Biopsy
---- Please select study-----
PET/CT Scan
Nuclear Medicine
MRI/MRA
CT Scan
Digital X-Ray
Fluoroscopy
Mammogram
BSGI Scan
PEM Scan
Ultrasound
Bone Density
Biopsy
(if apply)
Please rate how professional, helpful, friendly and courteous our staff was.
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Telephone Scheduling Staff
1
2
3
4
5
Front Desk Registration Staff
1
2
3
4
5
Technologists
1
2
3
4
5
Nurse (if applicable)
1
2
3
4
5
Radiologist (if applicable)
1
2
3
4
5
In general, did you feel the staff presented themselves in a professional and competent manner?
1
2
3
4
5
How would you rate the appearance and cleanliness of our office?
1
2
3
4
5
Overall, how would you rate your experience at Zwanger-Pesiri?
1
2
3
4
5
Was your appointment on the day/time you desired?
Yes
No
After registration, how long were you waiting prior to your study?
How did you initially hear of Zwanger-Pesiri?
Doctor Recommendation
Hospital
Radio Advertisement
Print Advertisement
Internet
Family/Friend
Other
What made you choose Zwanger-Pesiri?
Is there any staff member(s) who you feel deserves special commendation?
Please elaborate on any staff member(s) you feel needs improvement.
Do you have any other suggestions for our overall improvement?
Additional comments/questions
Would you recommend us?
Yes
No
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