Patient Survey

I was seen at:*
---Radiology Medical Group of Santa Cruz CountySanta Cruz Comprehensive ImagingDominican Breast CenterDominican MRI CenterSouth County Imaging

Type of Exam:*
MRIUltrasoundX-RayMammogramCTBone DensityOther

Physician/Provider that ordered the exam:

Please rate the registration desk personnel:
PoorFairAverageGoodExcellent

Please rate the technologist performing your exam:
PoorFairAverageGoodExcellent

Please rate your overall experience:
PoorFairAverageGoodExcellent

Would you recommend us to friends?
YesNo

Why would you recommend/not recommend us?

Would you like to recognize anyone specifically?

How did you hear about us?*
My PhysicianFriend/FamilyI have been here beforeI saw an adOnline researchOther

Name*

Email

Phone

May we use you testimonial anonymously?*
YesNo