Referring Physician Survey

Referring Physician Survey

By completing this survey you can help RAH focus its efforts and resources effectively while recognizing and prioritizing your needs. This survey is confidential and is for services specifically provided at the RAH outpatient centers. Thank you, in advance, for your contribution to this survey. We look forward to providing you with continued and improved imaging services.

Your support is appreciated.


REFERRAL PATTERN
Do you currently refer patients to RAH’s outpatient centers?
YesNo

If yes, please check the sites you most commonly refer.
AvonEnfieldGlastonbury

If you don’t refer patients to us, is there a specific reason why?


Please estimate the percentage of patient referrals you refer to RAH’s outpatient centers.
<20%21-40%41-60%61-80%81-100%

Has your referral pattern to our outpatient facility changed in the past year?
No, it has stayed the sameI send more patientsI send fewer patients

If you have changed your referral patterns to our outpatient facilities, please briefly tell us why.

Please rate our outpatient imaging services compared to other imaging facilities?
ExcellentGoodFairPoor

Do you find that patients are choosing their own radiology center?
YesNo


SERVICE
Who typically schedules imaging services for you?
PatientsPhysiciansOffice StaffOther

What hours of operation are most convenient for your patients?

Would your office be interested in the option of requesting appointments online?
YesNo

If yes, please provide an email address:

If you currently refer to our practice, please rate RAH’s services in the following areas:
Our ability to offer your patient a timely appointment
ExcellentGoodFairPoorNo

Our willingness to see urgent cases on short notice
ExcellentGoodFairPoorNo

The courtesy and responsiveness of our staff
ExcellentGoodFairPoorNo

The timeliness of receiving patient reports
ExcellentGoodFairPoorNo

Your patient’s comments about our practice
ExcellentGoodFairPoorNo

Hours of operation
ExcellentGoodFairPoorNo

If you have indicated a fair or poor rating, please tell us why:

If you are NOT AWARE we provide any of the following services, please check:
Online Reports & ImagesImages on CDThyroid BiopsiesBreast BiopsiesColor Dopplar U/SVirtual CT ColonoscopyBone DensitometryMRICT ScanDiagnosticsVaricose Vein TreatmentsMammography With Softer MammopadPresurgical Stereotatic CT Imaging of Sinuses

Have you seen or heard any of our advertising? If yes, choose all that apply:
Channel 3 TVChannel 30 TVCT Life PaperHartford CourantJournal InquirerCT MagazineThe ValleybookYellowpagesLittle Blue BookChamber of CommerceDirect MailingThe West Hartford Book

Name (optional)

Email (optional)