Feedback Form - ProRad Radiology

Customer Feedback Form

Date

Name

Phone Number

How did you hear about proRAD Medical Imaging?

Referring Doctor or Health Professional Family or friend recommentdation Live in the local community / Shop at Derrimut Village Shopping Centre Other

Why did you choose to have your radiology service at proRAD medical imaging?

Close to home/medical centre/work etc Appointments available Services offered Other

From your visit today, please rate us on the following

Easy of appointment making Needs attention Meets expectations Exceeds expectations

Physical environment and presentation of practice

Needs attention Meets expectations Exceeds expectations

Staff promptness in attending to your appointment

Needs attention Meets expectations Exceeds expectations

Friendliness and helpfulness of staff members

Needs attention Meets expectations Exceeds expectations

Any additional comments/suggestions?

Please tick for 'YES' if you would like a call back from proRAD's relation team

YES

PHONE

SEND EMAIL

ADDRESS

FAX