Patient Experience Survey

Which doctor did you see today?

Ahmed Farag

Joan Werber

Michael Racenstein

What procedure(s) did you undergo?

Please rate the following:

	Poor	Below Average	Neutral	Above Average	Excellent
Office Appearance

Cleanliness of Exam Room

Technologist Friendliness

Doctor Friendliness

Front Desk Staff

Waiting Time

Time in Exam Room

Time Waiting for Test Results

How easy was it to make an appointment that accommodated your schedule?

Were you satisfied with the level of communication between you and your doctor?

Are you a returning patient?

Yes

No

If this is your first visit, would you return?

Yes

No (Explain)

Would you recommend Diagnostic Imaging Specialists to a friend?

Yes

No

Maybe

Explain (optional)

How would you rate your overall experience at Diagnostic Imaging Specialists of Chicago?

What are we doing especially well at Diagnostic Imaging Specialists of Chicago?

What can we do to improve?

How did you hear about Diagnostic Imaging Specialists of Chicago?