Patient Survey: Quality of Care

Please rate each item by selecting the option that best describes your experience. Skip the question if it doesn't apply.

1 = poor : 5 = good

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. WE VALUE OUR PATIENTS AND THEIR COMMENTS.
THE SURVEYS ARE REVIEWED AND ARE THE BASIS FOR CHANGE AND BETTER SERVICE FOR OUR PATIENTS.

Which service did we provided?

X-Ray Ultrasound

1. Appointment Waiting Time: How quickly were you able to get an ultrasound appointment at this clinic?

1 2 3 4 5

2. Clinic Waiting Time: In the clinic waiting room, how quickly were you seen for your appointment?

1 2 3 4 5

3. Instructions: How well did the clinic staff (receptionists, technologists, sonographers) prepare you for the test(s) and what to expect both before and/or during the test(s)?

1 2 3 4 5

4. Ease of Getting Information: How willing were clinic staff to answer your questions?

1 2 3 4 5

5. Information You Were Given: Once the examination was explained to you, did you have the opportunity to ask any questions? Were your questions answered and were you comfortable with proceeding with the examination?

1 2 3 4 5

6. Concern and Caring by Clinic Staff: Courtesy and respect you were given, friendliness and kindness; how well clinic staff listened to what you had to say; how well did clinic staff understand what was important to you?

1 2 3 4 5

7. Safety and Security: Rate the provisions for your safety and the security of your belongings.

1 2 3 4 5

8. Privacy: How well was your privacy considered, for example, type of gowns used, privacy while changing clothes.

1 2 3 4 5

9. Instructions on Leaving: How clearly and completely were you told what to do and what to expect when you left the clinic?

1 2 3 4 5

10. Did your Ultrasound or X-ray service meet your expectations?

Yes No

If not, what would you change?

11. Would you recommend our clinic to a friend or family member if they needed our services?

Yes No

12. Overall Quality of Care: How would you evaluate the services you received and the way you were treated?

1 2 3 4 5

13. If there were some things you could change about this visit to improve it, what would they be?

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AdvantAGE Ontario

Ontario Association of Radiology Managers - OARM

Ontario Association of Medical Radiation Sciences - OAMRS

College of Medical Radiation Technologists of Ontario - CMRTO

Independent Diagnostic CLinics Association - IDCA