Patient Survey

Please take a few minutes to fill out this survey on the timeliness and the quality of the services(s) you received. We welcome your feedback and all your answers will be kept confidential. Thank you for your participation.

Your Visit
1. Your Exam was: *
2. Your Appointment was at which location: *
3. How did you hear about us? *
4. Name of your cardiologist: *

Please rate your leve of satisfaction for each question below:

5 = Excellent, 4 = very Good, 3 = Good, 2 = fair, 1 = Poor, N/A = Does Not Apply

A. Your Visit
1. How would you rate your visit today, overall? *
54321N/A
B. Our Front Office
1. Was our office staff kind, compassionate and communicative? *
54321N/A
C. Our Technologist
1. Was our technologist professional and informative regarding your test? *
54321N/A
D. Scheduling and Wait Time
1. Amount of time you waited? *
54321N/A
2. Ability to reach our office by phone for questions or to make an appointment? *
54321N/A
E. Our Facility
1. Was the facility clean, warm and inviting? *
54321N/A
F. Your Overall Satisfaction
1. Would you recommend our center to friend or family member? *
54321N/A
G. General
1. For any answer less than “5” above, please describe how we can improve our score: *
H. Security Code
Please answer this question

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