Patient Satisfaction Survey



Your feedback about your experiences at Advanced Imaging of Texarkana will help us serve you better in the future. We would very much appreciate a few minutes of your time to complete this survey.
Thank You!

Instructions:
Please think about your most recent visit to Advanced Imaging of Texarkana as you complete the survey form. When you are finished, click the "Submit Survey" button.

1. Name:
2. E-Mail:
3. Name of your Primary Care Physician:
4. What type of Exam did you have?
5. When did the Exam Take Place?
6. How long did you wait to be seen beyond your appointment time?
7. Did you find this waiting time acceptable or unacceptable?
8. Please rate the cleanliness and atmosphere of the Waiting Room:
9. Please rate the cleanliness and atmosphere of the Exam Room:
10. Please rate your experience with the Receptionist:
11. Please rate your experience with the Technologist:
12. Please rate your experience with the Physician:
13. Did the staff explain the exam to your satisfaction?
14. Overall, how would you rate your visit to Advanced Imaging of Texarkana?
15. Type any additional comments you may have below: