Referrer Satisfaction Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We would love to hear your thoughts or feedback on how we can improve your experience!

Your Name (Optional)

Name of Practice *

Have you always been able to contact NZMI to make a booking with ease?

Yes

Mostly

Sometimes

Clear selection

Has your reception at NZMI, by phone or otherwise, always been polite and helpful?

Yes

Mostly

Sometimes

Clear selection

Have you always been able to book a scan at a time that suits both your requirements and the patients?

Yes

Mostly

Sometimes

Clear selection

Have you always received your scan reports on time?

Yes

Mostly

Sometimes

Clear selection

Do you always find the reports clear and precise?

Yes

Mostly

Sometimes

Clear selection

Are you happy with the format in which you receive your reports?

Yes

Clear selection

Which format do you prefer to receive reports?

Mail

Fax

HealthLink

Format

Clear selection

Does NZMI offer the full range of nuclear Medicine services you require?

Yes

Mostly

Sometimes

Clear selection

To indicate your overall impressions of NZ Medical Imaging please circle one of the following?

Excellent

Good

Average

Poor

Clear selection

Suggestions for improvement

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms