Your Name

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* 1. Your Name

Who was your referring physician?

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* 2. Who was your referring physician?

Did you have a diagnostic imaging exam at a Radiology Associates covered facility?

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* 3. Did you have a diagnostic imaging exam at a Radiology Associates covered facility?

How satisfied are you with the service you received at this facility?

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* 4. How satisfied are you with the service you received at this facility?

How satisfied are you with the service you received from Radiology Associates?

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* 5. How satisfied are you with the service you received from Radiology Associates?

Is there anything Radiology Associates can do to improve the service offered to our patients?

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* 6. Is there anything Radiology Associates can do to improve the service offered to our patients?

Do you have any additional comments for Radiology Associates?

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* 7. Do you have any additional comments for Radiology Associates?

Would you like someone from Radiology Associates to contact you to discuss your experience?

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* 8. Would you like someone from Radiology Associates to contact you to discuss your experience?

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