FIFADI Physician Feedback Form

Physician Satisfaction Survey

The long-term success of this outpatient imaging center is dependent on its ability to provide the highest level of patient satisfaction so that it can successfully compete for referrals from satisfied providers. Your time completing this survey is appreciated.

Is the scheduling process easy for your staff and patients? Yes No
Where you able to schedule your patient in a timely manner? Yes No
Was the patient’s report received promptly? Yes No
Were you treated in a helpful, friendly and respectful manner? Yes No
Do you have all the tools necessary to assist your patients? Yes No
Overall, how would you rate our service based on your experience?
Excellent Average Poor
Overall, how would you rate our service based on your patient’s input?
Excellent Average Poor

Your comments are appreciated:

Name (optional)

Email (optional)

Phone (optional)

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