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Patient Satisfaction Survey

Your feedback is important to our ongoing efforts to provide you with the very best service.

"*" indicates required fields

1. When I called to schedule my exam, I was able to speak with someone quickly.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

2. The person who scheduled my exam was helpful and efficient.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

3. When I arrived, the receptionist was courteous and made me feel comfortable.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

4. I was seen at or near my appointment time.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

5. The procedure was fully explained to me.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

6. I was given understandable follow-up instructions.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

7. The medical staff performed my procedure with skill.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

8. I was treated with care and consideration.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

9. Patient responsibility and out of pocket expense clearly explained at time of check-in.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

10. I would recommend Hillsborough Radiology Centers to family and friends.

Strongly agree

Agree

Disagree

Strongly disagree

Does not apply

Additional comments

11. What procedure(s) did you have performed?

Please select all that apply

Mammogram

Ultrasound

DXA Bone Density

MRI Scan

CT Scan

X-Ray

Other

Other (please describe)

12. Why did you choose Hillsborough Radiology Center?

Please select all that apply

Recommended by my doctor

Convenient location

Directed by insurance carrier

Yellow Pages Ad

Recommended by friend/relatives

Newspaper Ad

Reputation for excellence

Radio/TV Spot

Had previous studies here

Website

Other

Other (please describe)

First Name*

Last Name*

Phone*

Email*

Name

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Our Location

Hillsborough Radiology
375 Route 206
Hillsborough, NJ 08844

Phone: (908) 874-7600
Fax: (908) 874-7052

Hours due to changing conditions, please call 908-874-7600 for information on current hours and available appointments.

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