Patient feedback helps us continually improve the service we provide. As Wilfred A. Peterson once said, “The secret of greatness is simple: Do better work than any other man in your field – and keep on doing it.” So please help us in our pursuit of greatness by filling out the following questionnaire.

(Please click the appropriate box or fill in the blank with an appropriate comment.)

1. Who scheduled your appointment?

Dr.’s office (Doctor’s name)



2. Did you have any trouble finding our center?

Yes No

3. Was your appointment scheduled at a convenient time for you?

Yes No

4. How long did you have to wait after you arrived?

Less than 5 minutes 5-10 minutes

10-20 minutes 20+ minutes

5. What was your general impression of our secretarial staff behind the counter? (Check all that apply)

Friendly Happy Polite Abrupt Rude


6. What was your general impression of the technologists (the people who performed the exam)? (Check all that apply)

Knowledgeable Experienced Cooperative

Disagreeable Rude


7. What was your overall impression of the center?

Excellent Good Fair Poor


8. Would you return to our center for another MRI scan?

Yes No

9. Would you recommend our services to a friend or relative?

Yes No

10. Do you have any other comments or suggestions that may help us to improve our services?