We appreciate our patient's comments!

Name:

E-mail:

Date:


Who made your appointment?

You

Your doctor’s office


Were we able to accommodate your scheduling requests?

Yes

No

Comments:


When calling with questions, did you find
the front desk staff to
be courteous and informative?

1 meaning Above-Average, 5 meaning Below-Average

1 2 3 4 5 Did not call


Did RDC staff call to
pre-register you prior to your appointment?

Yes

No

Comments:


Did you feel the
pre-registration process expedited your check-in process?

Yes

No

Comments:


When you came in for
your exam, were you greeted by a professional and friendly staff?

Yes

No

Comments:


If you were kept waiting, was the reason for
the delay explained
to your satisaction?

Yes
No
Was not kept waiting

Comments:


Did the technologist
explain the procedures
or examinations so you could understand?

Yes

No

Comments:


Did your technologist
make you comfortable during your examination?

Yes

No

Comments:


Have you seen or heard
RDC’s advertisements?

Yes, please check source below No

Radio
Television
Newspaper
Yellow Pages
Community Health Fairs
Don’t remember source


Was RDC’s location
easy to reach?

Yes

No

Comments:


Are there members of
our staff that you wish to give special recognition?


Do you have any suggestions for us?


All comments are reviewed at our monthly Quality Assurance Meetings and appropriate improvements are made to better serve you, our valued patient.
Thank you!