X-Ray Associates Patient Survey

What type of procedure did you have?:
Nuclear Medicine

Date of Service:

Which X-Ray Associates location did you receive the indicated services from?
679 Davis Drive, Newmarket
125 Pedersen Drive, Aurora
250 Harding Blvd., Richmond Hill
955 Major Mackenzie Drive, Vaughan

Please rate each item by selecting the rating that best describes your opinion. Please complete all fields prior to submitting.





Very Good



1. Waiting time: How long you had to wait to get an appointment at this clinic

2. Waiting time: How was your wait in the waiting room before you were seen

3. Instructions: How well and how clearly were your preparations for the test explained to you by the clinic staff

4. Ease of getting information: Willingness of the clinic staff to answer questions

5. Overall treatment: How well did the staff listen and understand what was important to you (e.g. Concern, care, respect, friendliness, kindness)

6. Safety and Security: How well did the staff provide for the safety and security of your belongings

7. Privacy: How well was your privacy considered (e.g. type of gowns used, privacy while changing)

8. Instructions on leaving: How clearly and completely were you told of what to do and what to expect after you have left the clinic

9. Would you recommend this clinic to a friend or family member if they needed the services of this clinic



10. Did the clinic offer a report for your test in time to meet your medical needs



11. Overall quality of care: How would you evaluate the services and the treatment you received in this clinic

12. What suggestions or changes would you recommend to improve our service?
13. If you would like to be contacted about your concerns please add your name and telephone number.
Full Name:   Phone Number: * Optional