Patient Survey

General

Which imaging center did you visit?    Please select from Drop-down List Crown Interventional: 5284 Medical Drive, #102 Crown MR: 5282 Medical Drive, #180 Four Seasons Breast Center: 325 Sonterra Blvd. E, # 240 Medical Center: 2829 Backcock, # 215 Northeast: 12602 Toepperwein Rd, #101 Sonterra, 325 Sonterra Blvd. E, # 120 SouthSide: 7333 Barlite, #200 Stone Oak: 540 Oak Center Drive, #100 Village Drive: 8500 Village Drive, #102    

*Required Field

What was the date you visited one of our imaging centers?

*Required Field

  Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2005 2004 2006 2007 2008

What examination(s) did you have performed?

(For multiple studies please select one from each drop-down box)

Study 1:  Other (Please specify below) or Not Applicable MRI MRA Ultrasound Vascular Ultrasound PET Scan DXA Scan Nuclear Medicine CT Scan CTA Scan Mammogram

Study 2:   Other (Please specify below) or Not Applicable MRI MRA Ultrasound Vascular Ultrasound PET Scan DXA Scan Nuclear Medicine CT Scan CTA Scan Mammogram

Study 3:   Other (Please specify below) or Not Applicable MRI MRA Ultrasound Vascular Ultrasound PET Scan DXA Scan Nuclear Medicine CT Scan CTA Scan Mammogram

If your study is not listed above please enter here:

Your Visit

Please select your answer:

Excellent

Above Average

Average

Poor

Scheduling Polite/Knowledgeable

Receptionist Polite/Knowledgeable

Technologist Professional/Caring

Convenient Location

Comfortable Waiting Area

Our Service

Please select your answer:

Yes

No

Pleased with your care?

Did you hold long when scheduling?

Did you wait long to be called back?

Would You Ask Your Dr. to refer you to us again?

Was any employee especially helpful to you?

Additional Comments:

Helping you

How could this website be more helpful to you?

Would you like one of our representatives to contact you to discuss any matters regarding your experience with Advanced Medical Imaging?  If so:

Please note:  The connection that you are using is unsecured and the information you are sending will not be encrypted.  AMI cannot guarantee such information will be protected.  Once the information reaches AMI it will be protected in accordance with our Notice of Notice of Privacy Practices (NPP).

Your name:

Telephone number where you can be reached at:

Please press the "Submit" button below once you have completed the form or the "Clear Form" to start over.

Thank you for taking the time to provide us with feedback.

Referring Physicians Office Survey

General Feedback

Which AMI imaging center(s) you primarily refer to?

Please select from Drop-down List Crown Interventional: 5284 Medical Drive, #102 Crown MR: 5282 Medical Drive, #180 Four Seasons Breast Center: 325 Sonterra Blvd. E, # 240 Medical Center: 2829 Backcock, # 215 Northeast: 12602 Toepperwein Rd, #101 Sonterra, 325 Sonterra Blvd. E, # 120 SouthSide: 7333 Barlite, #200 Stone Oak: 540 Oak Center Drive, #100 Village Drive: 8500 Village Drive, #102

Which study (ies) do you usually schedule?

Other (Please specify below) or Not Applicable MRI MRA Ultrasound Vascular Ultrasound PET Scan DXA Scan Nuclear Medicine CT Scan CTA Scan Mammogram

Other:

Is this survey response specific to a particular issue?  If yes please add your comments here:

Would you like one of our representatives to contact you to discuss any matters regarding your experience with Advanced Medical Imaging?  If so:

Please note:  The connection that you are using is unsecured and the information you are sending will not be encrypted.  AMI cannot guarantee such information will be protected.  Once the information reaches AMI it will be protected in accordance with our Notice of Privacy Practices (NPP).

Your name:

Telephone number where you can be reached at:

Any additional comments you wish to be brought to our attention?

Please press the "Submit" button below once you have completed the form or the "Clear Form" to start over.

Thank you for taking the time to provide us with feedback.