Referring Physician Satisfaction Survey

1.Physician Name

2.Please tell us about your practice:

What is your specialty?

How many doctors are in your practice?

What city are you in?

Select One:

Practice Name

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

Report Quality

Report Turnaround Time

Radiologist Availability

Subspecialty Reads

Billing

Other:

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?

Yes

No

If not, what resources do you need?

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

Yes

No

If yes, who are these radiologists?

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

Yes

No

If yes, please provide your preferred method of communication.

11.Any additional comments or questions?