REFERRING PHYSICIAN SATISFACTION SURVEY

QUALITY ASSURANCE

Please indicate the level of satisfaction that best reflects your experience with Columbia-Presbyterian Eastside Radiology by circling the appropriate number:

1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied

CLERICAL SERVICES:
Courtesy and helpfulness of office staff ................................................................. 1 2 3 4 5
Calling to make an appointment ............................................................................. 1 2 3 4 5
Phones answered promptly & hold time is minimal ................................................ 1 2 3 4 5
Timely response to voice mail messages .............................................................. 1 2 3 4 5
Level of knowledge/courtesy of our front desk employees ................................... 1 2 3 4 5
Front desk interaction with your patients ............................................................... 1 2 3 4 5
FILMS & REPORTS:
Accuracy of reports ............................................................................................... 1 2 3 4 5
Receive faxed reports when requested ................................................................ 1 2 3 4 5
Ease of access to Amicas ..................................................................................... 1 2 3 4 5
Quality of Amicas images ...................................................................................... 1 2 3 4 5
Receive wet reads when requested ...................................................................... 1 2 3 4 5
Efficiency of film delivery ....................................................................................... 1 2 3 4 5
Courtesy of film delivery courier ........................................................................... 1 2 3 4 5
TECHNICAL SERVICES:
Level of professionalism/knowledge of technical staff .......................................... 1 2 3 4 5
Technologist interaction with your patients ........................................................... 1 2 3 4 5
Feedback from patients about technologists ........................................................ 1 2 3 4 5
OVERALL SERVICES
Selection of appointment times .............................................................................. 1 2 3 4 5
Availability of urgent appointments ........................................................................ 1 2 3 4 5
Days/hours of service ........................................................................................... 1 2 3 4 5
Patient wait time ..................................................................................................... 1 2 3 4 5
Level of knowledge/courtesy of billing office staff ................................................. 1 2 3 4 5
Feedback from your patients about office staff .................................................... 1 2 3 4 5

Quality of professional readings:
MRI ..........................................................................................................
1 2 3 4 5
CT ............................................................................................................
1 2 3 4 5
Mammography ........................................................................................
1 2 3 4 5
Ultrasound ...............................................................................................
1 2 3 4 5
Quality of images:
MRI ..........................................................................................................
1 2 3 4 5
CT ............................................................................................................
1 2 3 4 5
Mammography .........................................................................................
1 2 3 4 5
Ultrasound ................................................................................................
1 2 3 4 5
Overall experience . ............................................................................................... 1 2 3 4 5


Please complete reverse side for needs assessment.

NEEDS ASSESSMENT

Please rate the importance of the following:
1 =not important, 2 = slightly important, 3 = important, 4 = very important, 5 = essential

Reputation of faculty and CPER ............................................................................ 1 2 3 4 5
Accessibility of Radiologists .................................................................................. 1 2 3 4 5
Office visit from Marketing Representative ........................................................... 1 2 3 4 5
Quality of diagnostic equipment ............................................................................. 1 2 3 4 5
Travel distance for patient ..................................................................................... 1 2 3 4 5
Availability of parking ............................................................................................. 1 2 3 4 5
Participation with managed care plan .................................................................... 1 2 3 4 5
Availability of urgent and same-day appointments ................................................. 1 2 3 4 5
Access to electronic (digital) images ..................................................................... 1 2 3 4 5
Receipt of films with negative findings .................................................................... 1 2 3 4 5
Receipt of films with positive findings ...................................................................... 1 2 3 4 5
Wet readings ........................................................................................................... 1 2 3 4 5
I.V. sedation available ............................................................................................. 1 2 3 4 5

Who typically schedules imaging services for your office?

Patient Physician Office Staff

Who selected CPER?

Your Medical Specialty

If you were not aware we provide a following service, please check: On-line reports/films Images on CD Images printed on paper MRA Virtual Colonoscopy Coronary Scoring Lung Screening Nuclear Medicine Bone Density Stereotactic Biopsy Breast MRI

Are there any other procedures you would like is to perform?

How can our services be improved?







I need requisition pads/insurance list. Please send to:

THANK YOU FOR YOUR PARTICIPATION!
Your response is important to us.

Name (Optional): Phone:

Please send your questionnaire in the enclosed postage-paid return envelope, or fax to 212-326-8870, Attn: Vera Brooks This questionnaire is also available on our website at www.cper60th.org


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