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How would you rate your scheduling experience? |
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
|
When you arrived for your appointment, were you seen at your scheduled time? |
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
|
When you arrived for your appointment, were you greeted in a friendly manner by the front desk? |
Yes
No
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Did the technologist performing your exam introduce his/herself? |
Yes
No
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Did the technologist explain your exam to you? |
Yes
No
|
Did you feel you were treated in a polite and professional manner? |
Yes
No
|
Was the office neat and clean? |
Yes
No
|
How would you rate the parking experience? |
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
Comments
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How would you rate your waiting room experience? |
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
|
How would you rate your overall experience at CMI? |
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
|
Have you visited our website prior to your appointment? |
Yes
No
|
Have you heard our radio ad with Dr. John Picano?
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Yes
No
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Was this your first visit as a patient to CMI? Yes/No |
Yes
No
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Which location did you visit? |
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Was there anything we could do to make your experience with us better? |
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Name / Address (Optional): |
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