Thank-you for choosing Southeastern Med as your imaging provider.  In an effort to understand and meet our patient’s needs, we would like for you to fill out the following survey.  Thank-you in advance for helping us improve our patient care.

Please check the appropriate response to each question.

                         Area of testing:          X-ray     Cat-Scan    MRI     Ultrasound   
                      Nuclear Medicine         Mammography
                      Angiography (arteriography)

Time of Service            am                      pm

Yes      No

           1.  Were you greeted in a warm friendly manner?

           2.  Were you escorted to the testing area?

           3.  Did the person/persons you had contact with introduce themselves?

           4.  Was your exam explained to you, prior to your test by your doctor?

           5.  Did the technologist explain your exam to you?

           6.  Was your test done in a timely manner?

           7.  If no, was there an explanation offered for the delay?

           8.  Were the room conditions comfortable and clean?

           9.  Was the technologist or nurse friendly during your exam?

        10. Were you escorted from the testing area with clear directions to exit?

         11. Would you return to Southeastern Med, for further imaging services?

Additional Comments

Southeastern Med-Diagnostic Imaging Services
Patient Care