Imaging Survey Please enable JavaScript in your browser to complete this form.Your VisitDate of ServiceService PerformedMRICT ScanX-RayHow did you hear about us?Doctor ReferralFriendAdvertisementWebsiteOtherIf other, please explain:Please Rate the Following StatementsThe staff was courteous.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeI received clear information from the staff.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeThe staff was knowledgeable.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeThe facility was comfortable and clean.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeMy appointment date and time was reasonable and convenient to me.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeI would recommend MEDRVA Imaging to a family member or friend.Strongly AgreeAgreeUncertainDisagreeStrongly DisagreeCommentsSubmit
