Patient Survey

Thank you for your participation in the survey. It will take approximately 5 minutes to complete. Our goal at Sutter Buttes Imaging is to provide the highest quality imaging services to our patients and your completion of this questionnaire will assist us in improving our services to you.

Your Name

Your E-Mail

1. During your visit to Sutter Buttes Imaging, did someone provide you with a clear explanation of your imaging examination?
 Yes, definitely Yes, somewhat No

2. During your visit, did someone listen to you carefully and answer any questions and concerns you might have had about your imaging examination?
 Yes, definitely Yes, somewhat No

3. During your visit, did someone have crucial information about your medical history ("priors") as it related to the imaging examination to be performed?
 Yes, definitely Yes, somewhat No

4. Do you feel our personnel spent enough time with you during your visit?
 Yes, definitely Yes, somewhat No

5. Were you satisfied with your understanding of who would be responsible for interpreting your imaging examination?
 Yes, definitely Yes, somewhat No

6. Were you satisfied with your understanding of when, and to whom, the results of your imaging examination would be communicated, and how those results would then be communicated to you?
 Yes, definitely Yes, somewhat No

7. Did you ask to meet or speak to a radiologist about the results of your exam?
 No, I did not know this was an option No, I did not feel it was necessary to meet or speak with a radiologist Yes, I wanted to meet or speak with a radiologist, and was able to do so Yes, I wanted to meet or speak with a radiologist, but he/she was unavailable

8. Overall, how did you rate the care you received during your most recent visit?
 Excellent Very Good Good Fair Poor Not applicable

9. Based on your most recent visit, would you recommend Sutter Buttes Imaging to others?
 Definitely would Probably would Unsure Probably not Definitely not Not applicable

10. In general, how would you rate your overall health?
 Excellent Very Good Good Fair Poor

11. What is your age?
 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older

12. Are you male or female?
 Male Female

13. What is the highest grade or level of school that you have completed?
 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree

14. Did someone help you complete this survey?
 Yes (If yes, please proceed to Question 15) No

15. How did that person help you? Check all that apply.
 Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way

Additional Notes, Ideas or Suggestions?