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Patient Survey
Daisy Uppal, M.D.
2019-02-12T16:50:57-05:00
Name
First
Last
Phone
Email
Which of our locations did you visit?
*
Columbia
Reisterstown
How easy was it to make your appointment?
*
Very Easy
Somewhat Easy
Neither Easy Nor Difficult
Somewhat Difficult
Very Difficult
Please rate your experience with the staff
*
Very Satisfied
Somewhat Satisfied
Average
Somewhat Dissatisfied
Very Dissatisfied
I did not interact with the staff
Please rate the cleanliness of our center
*
Very Clean
Somewhat Clean
Neither Clean Nor Unclean
Somewhat Unclean
Very Unclean
Did you get to interact with the Radiologist/Doctor?
*
Yes
No
Do you have any comments or suggestions?
On a scale of 1 to 5 with 1 being poor and 5 being wonderful, how would you rate your overall expereince at Charter Radiology?
*
5
4
3
2
1
Email
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