On-Site Mobile Experience Survey

On-Site Mobile Services Experience Survey

Please take a few moments to provide insights about your experience with our On-Site Mobile

X-ray services. We value your opinion and hope to collaborate on suggestions and comments provided for the best possible outcome in all cases. The information received is reviewed regularly as part of our quality assurance program. Thank you for sharing with us today.

Administrative Services

How professional was the staff member who helped set up this service?

Was the staff member you dealt with knowledgeable?

Were your questions answered in a timely manner?

Images and Reports

Accuracy of reported findings:

Did you receive the reports when requested?

Technical Services

Level of professionalism and knowledge of technical staff:

Technologist interactions with your employees during the exam.

Did your employees provide any feedback about technical staff?

Communication

Was our management team accessible to you?

Was our technical staff responsive to questions?

Was communication delivered respectfully?

Patient Centered Care and Ethics

Were employees treated with respect and dignity?

Did employees feel safe during the examination?

Was employee privacy supported by technical staff?

Comments or Other Suggestions

Overall, how would you rate your most recent on-site service experience?

How would you rate our on-site service compared to others?

How likely are you to use our mobile services again?

How flexible is scheduling to gain access to your site location? (limiting variables such as inclement weather, flight delays, shut downs)

Is there a preferred time of year or time-frame of which to arrange on-site visits?

Is there anything we can do to improve our mobile services?

If you would like to discuss with our management team, please check:

Yes No

Contact Information

If you answered yes to having our management team reach out to discuss your form with you, please provide us with your contact information below

Name:

Designation:

Site Facility Name/Industry or Private Office:

Best Daytime Phone Number:

* Email: This field is required to receive our confirmation email after submitting this form.

Date of Service:

Site Name and Location:

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Survey - Mobile

On-Site Mobile Services Experience Survey