In an effort to improve our services, we are asking our valued referrers to fill out the following survey. Because you have established yourself as a supporter of the Magnetic Imaging Center, we value your opinion and are willing to seriously consider any advice you are willing to offer us.

Please fill out the survey, adding any comments you feel would be helpful to us.

Thank you, in advance, for your time and sincere comments. We look forward to a continued business partnership. If you have any questions or comments please feel free to call us at 717.920.5103.

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

Name of Office

Name of person filling our questionnaire

Date

Do you presently refer your patients to the Magnetic Imaging Center for MRI?

Yes No

If not, why?

What other facilities do you use and why?

What could we do better for you?

Is there any way we could “win” your business?

Have you navigated our website?

Is there anything you’d like to see on the website that wasn’t there?

How often do you refer for MRI? (Check one)
Every day A few times per week
A few times per month Rarely
Never

What types of MRI cases do you normally refer?
Musculoskeletal Cardiac Breast
Abdominal Brain Spine
Other:

Would you be interested in receiving information about a specific type of scan?
Yes No

Which one(s)?

Do your practitioners feel they have enough information (indications) to order MRI for our newest technologies (i.e., breast, cardiac, abdominal)?
Yes No

Have you ever attended one of our clinical dinner lectures?
Yes No

Would you be interested in receiving information about them?
Yes No

How does your office like to receive your patients’ MRI results?
Film CD Just the report Internet

When you receive a report, do you prefer that it be:
Mailed Faxed Both

In your office, who makes outside diagnostic testing referrals for your patients? (name/s, if possible)

How do they determine where a patient should go?
Insurance Locale Quality
Ease of scheduling Reputation of facility
Patient comfort level
Other:

Do you receive your MRI report in a timely manner without having to request it?
Yes No

Would you be interested in having us conduct an informational luncheon for your staff in your office? (Provide us with a contact name, title, and phone number of your office representative with whom we can make arrangements)

Name:

Title:

Phone Number:

Would you be interested in touring our center and observing an MRI?
Yes No

May we have the name of your office manager?

Your fax number?

Do you have an office web site?
Yes No
If Yes, your URL:

Office email?
Yes No
If Yes, your address:

Please add any additional pertinent comments you would like to share with us.


Thank you.



.