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Which of our facilities did you visit?	Warning: Invalid argument supplied for foreach() in /home/sites/www.bayareamri.com/web/referrals/includes/includes.php on line 614 Select Facility
Referring Physician Name:	Please select physician... Other: Search last, first name (Other) (max 50)
Select Head Scan Brain Posterior Fossa IAC Pituitary Brainstem Orbits Select Spine Scan Cervical Thoracic Lumbar Sacrum Select Joint Scan Hip Knee Ankle Shoulder Elbow Wrist Select Vascular Scan Interacranial MRA Neck MRA Thoracic Aorta Select Miscellaneous Scan Pelvis Abdomen Mediastinum Exam Performed:	MRI CT Ultrasound Nuclear Imaging Other:
How did you hear about our facility?	Select from list Physician's Office Yellow Pages Internet Driving By Insurance Company Previous Visit Other
How long did you have to wait for your exam upon arrival?	Select Wait Time 5 minutes or less 10 minutes 20 minutes 30 minutes or more
Would you use us again or recommend us to a friend?	YES      NO

	Excellent	Above Average	Satisfactory	Poor
Our location was convenient and accessible
Our reception area was clean and tidy
Our front office staff was helpful and courteous
Our technologist was helpful and courteous
Our registration process was easy and efficient
The procedure was properly explained to you
Our scheduling procedure and availability met your needs
The billing and collection process was properly explained
How would you rate our service overall?

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