* 1. Your Name

* 2. Who was your referring physician?

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

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

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

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

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

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

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