South Texas Radiology Imaging Centers

Visit Feedback Form

Please take a moment to answer a few questions about the service you received during your recent visit.

Use the scale of 1-10 with 10 being the highest and 1 the lowest to answer the following questions:

1. How would you rate our reception staff?	Comment
2. How would you rate the cleanliness and comfort of the facility?	Comment
3. How friendly and professional was the technologist?	Comment
4. Did the technologist explain the procedure prior to your exam?	Comment
5. Did you feel that you had to wait a long time in the reception area?
6. How long was your wait time in minutes?	Comment
7. Do you have suggestions on how we could improve our services?	Comment
Your Name: Your Phone: Imaging Center that you visited: Type of Exam: Date of Exam: