Date:
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Please rank the following:

Poor

Meets Expectations

Excellent

	1	2	3	4	5
Ease of scheduling
Appointment availibility
Directions
Speed of registration
Report turnaround time
Quality/completeness of reports
Access to radiologists
Quality/clarity of radiologist's response
Overall satisfaction
Based on patient feedback, patient's satisfaction

Would you recommend Radia to a collegue, friend or family member?

Yes No

Do you have any suggestions for us?

Would you like us to contact you?

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