Patient Feedback Form

Diagnostic Imaging Services

Thank you for choosing our diagnostic imaging services. Your feedback is important to us and helps us improve our services. Please take a few moments to complete this form.

Date of Visit: *

Section 1: Patient Information (Your responses will remain confidential.)

Location of Service: *

Type of Imaging Service Received *

(e.g., MRI, CT, X-ray, Ultrasound)

Was this your first visit to our facility? *

How would you rate your overall experience? *

Excellent
Good
Fair
Poor

Section 2: Service Experience

How would you rate the professionalism and friendliness of the staff? *

Excellent
Good
Fair
Poor

Section 2: Service Experience

How satisfied were you with the clarity of instructions provided before and during the procedure? *

Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied

Section 2: Service Experience

How would you rate the cleanliness and comfort of the facility? *

Excellent
Good
Fair
Poor

Section 2: Service Experience

Did you experience any issues during your visit? (Yes/No) If yes, please describe: *

Section 3: Additional Feedback

Do you have any suggestions for improving our services? *

Section 3: Additional Feedback

Would you recommend our services to others? (Yes/No) Why? *

Section 3: Additional Feedback

Full name

First

Last

Optional: Contact Information. If you would like us to follow up on your feedback, please provide your contact details:

Phone Number

Optional: Contact Information

Thank you for your time! Your feedback helps us enhance our services.

Address

Westland Medical Centre , Hornchurch RM11 3SD, UK

Call Us

+44 7395 793125

Email Us

info@heartstonegrp.org

Professional & Training

Our Main Services

Ultrasound Services
Policy & Statement
Pathology Testing

Registration & Training

NHS Digital
Society of Radiographers
The UK Caldicott Guardian Council
Information Commission Office
Care Quality Commission

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