AMI Survey

Please rate your satisfaction with the service provided by Advanced Medical Imaging:

1:Never      2:Rarely      3:Sometimes      4: Usually      5: Always
Check in, registration, and wait time was acceptable to me?
The staff was friendly and professional? 1 2 3 4 5
I would ask my doctor to use Advanced Medical Imaging again? 1 2 3 4 5
 
How did you choose Advanced Medical Imaging? Advertising Referring Physician Other
Did you have any questions or concerns that were not answered satisfactorily? Yes No
If yes, please comment:
What do you like best about us?
Where do we need to improve?
 
Date of scan: Name (Optional): Referring Physician:
May we use your comments for training and/or marketing purposes? Yes No
Would you like to discuss the service you received at Advanced Medical Imaging? Yes No
If yes, phone number: Best time to call:
Email (Optional):