Radiology Satisfaction Survey

*First Name

*Last Name

Title

Facility Name

Mailing Address

Phone Number

*Email Address

Hours / Levels of Coverage Not Satisfied
Very Satisfied

Modalities Covered Not Satisfied
Very Satisfied

Timeliness of Reporting Not Satisfied
Very Satisfied

Quality of Radiology Reports Not Satisfied
Very Satisfied

How long have you been using your current radiology group? 1 Year or Less
1-3 Years
3-5 Years
5-10 Years
More than 10 Years

In what areas would you like to see improvement? (Check all that apply) Medical Staff Relationships
Quality
Reduction of Subsidies
Report Timeliness

Would you like to receive additional information from AllegiantMD? No
Yes

Additional Comments