Referring Physician Satisfaction Survey

Your opinions matter to us. An important indication of the quality of services we provide is how our referring physicians feel about the care we provide to their patients, the timeliness of our communication with them and the availability of our staff to answer your questions. Please take a few moments to complete the following brief survey.

1. Do you find MMI’s requisitions easy to use and understand?
 Agree Somewhat agree Neutral Somewhat disagree Disagree

2. How satisfied are you with the following:

a) Timeliness of reports?
 Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied

b) The information that is included in the reports?
 Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied

c) The length of time it generally takes for your patients get an appointment at our facility?
 Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied

3. How accessible are our physicians by phone when you have a question?
 Very accessible Somewhat accessible Neutral Somewhat inaccessible Very inaccessible

4. Why do you refer patients to MMI (please tick all that apply)?
 Location Range of tests offered Short waiting lists Report turn-around time Convenient hours of operation Overall quality of services provided
 Other (please specify):

5. Would you recommend MMI’s services to other physicians?
 Yes No

If no, please indicate why not:

6. Do you have suggestions on how we could improve upon the services we currently provide?

If you would like to be contacted in reference to this survey, please provide your name, phone number and/or email address.

Phone Number
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Thank-you for taking the time to complete this survey. The information on this form is strictly confidential and will be used solely by Merivale Medical Imaging for the purpose of operational quality control.