- OR -
Please take our Patient Service Satisfaction Survey - We would like to hear from you!
 
The Hartford Hospital Quality Management Department is conducting this survey to assess patient satisfaction at the Imaging Center. 
 
The data is compiled and a report is generated quarterly by the Quality Management Department and evaluated by the Imaging Center. 
 
IMPORTANT NOTICE: Information provided through this survey is confidential and anonymous. If you have a specific question or concern, please contact us. Thank you for taking our customer satisfaction survey!

Patient Service Satisfaction Survey                                                       * = Required Field

* Procedure/Service for which you are providing feedback (select one):
Bone Densitometry
BW2R
CT
Interventional Radiology
Mammography
MRI
General Diagnostic/Fluoroscopy
Nuclear Medicine
Ultrasound
Film Record Management
Other Procedure/Service
* 1. Was your exam performed at 
     the time of your appointment?
Yes  No  Waited greater than 20 minutes
* 2. Did the staff treat you with
     courtesy and respect?
Yes  No 
* 3. Was your exam explained to you
      in a way you could understand?
Yes  No 
* 4. Did the staff listen carefully to
     you if you had a question or
     concern?
Yes  No 
  5. How did you hear about 
     Hartford Hospital's Imaging
     Center?
Physician Referral
Phone Directory
Advertisement (radio/TV/newspaper)
Friend/Family
Hartford Hospital Website
* 6. How would you rate your
     overall experience at the
     Imaging Center at Hartford
     Hospital?
Excellent Good  Fair  Poor  Very Poor
* 7. Would you recommend the
     Imaging Center of Hartford
     Hospital to others?
Definitely Would
Probably Would
Probably Would Not
Definitely Would Not
  8. Is there anyone you
     would like to recognize
     for exceptional service?
  9. Please share with us any
     positive comments or
     areas for improvement:
Optional:
      Name:  
     Phone:     Email:  

* Security Code:


     Enter the code shown above: