* 1. Physician Name

* 3. How would you rate your overall experience with Radiology Associates?

* 4. In comparison with other radiology practices, how would you compare the following services?

  Poor Below Average Average Above Average Excellent
Report Quality
Report Turnaround Time
Radiologist Availability
Subspecialty Reads

* 5. How would you like to see these services improve?

* 6. What percentage of your referrals go to a Radiology Associates covered facility?

* 7. What non Radiology Associates covered facilities do you send to? Why do you refer to these facilities?

* 8. Do you have all of the resources you need to refer patients to a Radiology Associates covered facility?

* 9. Do any of our physicians provide above average service to your practice?

* 10. Would you like to be contacted by one of the radiologists?

* 11. Any additional comments or questions?