Date:
Location:

Please rank the following:

Poor

Meets Expectations

Excellent

	1	2	3	4	5
ER
Radiologist availibility for immediate consult
Reports are consistently what you expected, or better
Timelines of reporting to your department and staff
Positive staff interaction
Positive process for ER doctor and staff
DI or Radiology Department
Help with technical support
Positive staff experience with the process
Positive interactions with your technologies and/or staff
Overall process helpful
Radiology Group
Questions regarding an opinion resolved to your satisfaction
Quality and content of interpretation
Positive staff experience with the process
Overall process helpful

If a 1 through 3 on any of the above, please explain:

Do you have a specific suggestion on ways Radia can improve service to you?

Does your office have needs that are not being addressed?

Thank you for completing this teleRadia™ Satisfaction survey. Would you like us to contact you?

Yes No

Name:
Phone: