Your diagnostic visit — quick feedback

Tell us about preparation, privacy, and care during your procedure.

About 2 minutes. Your feedback improves imaging and diagnostics for everyone.

Questions marked * are required.

Visit code from reception *

Ask reception for a one-time code after payment. Without this code you cannot submit feedback.

Who is filling this form? *

Patient (myself)Parent / guardianOther family memberOther

What service did you receive today? *

Overall, how was today’s visit? *

1 — Very poor5 — Excellent

How would you rate reception / registration / payment today? *

1 — Very poor5 — Excellent

Was the waiting time acceptable? *

YesSomewhatNo

Were staff polite and respectful? *

1 — Very poor5 — Excellent

How clean and comfortable was the facility? *

1 — Very poor5 — Excellent

Were preparation instructions clear? *

Yes, clearlyPartlyNoNo special prep needed

How well was your privacy and dignity respected? *

1 — Very poor5 — Excellent

How professional and reassuring was the technician / staff? *

1 — Very poor5 — Excellent

How comfortable was the procedure experience? *

1 — Very poor5 — Excellent

What is one thing we could improve? (Optional)

What did we do well today? (Optional)

May we contact you about this feedback?

No, keep anonymousYes

Name *

Phone *

Preferred time *

Visit code from reception *

Who is filling this form? *

What service did you receive today? *

Overall, how was today’s visit? *

How would you rate reception / registration / payment today? *

Was the waiting time acceptable? *

Were staff polite and respectful? *

How clean and comfortable was the facility? *

Were preparation instructions clear? *

How well was your privacy and dignity respected? *

How professional and reassuring was the technician / staff? *

How comfortable was the procedure experience? *

How likely are you to recommend us to others? *

What is one thing we could improve? (Optional)

What did we do well today? (Optional)

May we contact you about this feedback?