Patient Survey

Name

First Last

Phone

Email

Which of our locations did you visit?*

How easy was it to make your appointment?*

Please rate your experience with the staff*

Please rate the cleanliness of our center*

Did you get to interact with the Radiologist/Doctor?*

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 experience at Charter Radiology?*

Name

This field is for validation purposes and should be left unchanged.