Patient Satisfaction Survey

BASC Imaging strives to provide the best patient experience. To help ensure that we are doing everything possible to accomplish this goal, please fill out the following questionnaire and return it using the self-addressed stamped envelope.

We thank you for your time and attention, and for choosing BASC Imaging

Reception

Was the Scheduling Coordinator courteous and helpful during scheduling?

Yes No

Was the BASC Imaging Receptionist professional and efficient at check in?

Yes No

Procedure – Circle One

MRI CT US

Was the Technologist friendly, respectful and professional?

Yes No

Was your exam explained to you?

Yes No

Did the Technician listen carefully to your concerns?

Yes No

Were all of your questions/concerns about your exam answered?

Yes No

Were you overall satisfied with your experience?

Yes No

BASC Imaging

Did you find the facility clean and comfortable?

Yes No

Did you feel that your privacy was protected throughout your stay?

Yes No

Would you return to BASC Imaging in the future?

Yes No

Would you recommend BASC Imaging to a friend or relative?

Yes No

How did you hear about BASC Imaging?

Was there someone you found to be outstanding in their service or concern for you?

We would appreciate any additional comments and/or suggestions below. Your input is highly valued and very much appreciated.

You can leave any questions or concerns about your imaging service experience at info@bascimaging.com

Please do not include personal health information (PHI), medical information, diagnoses, test results, or other sensitive personal information in this survey. This form is intended for general feedback about your experience with BASC Imaging only.

Patient Satisfaction Survey

BASC Surgery & Endoscopies

(603) 622-3670 / Fax: (603) 626-9750

11 Washington Place, Bedford, NH 03110

BASC Imaging

(603) 296-0723 / Fax: (603) 232-0056

20 Washington Place, Bedford, NH 03110

BASC Eye Institute

(603) 623-2020 / Fax: (603) 623-2025

11 Washington Place, Bedford, NH 03110

BASC Surgery & Endoscopies

(603) 622-3670 / Fax: (603) 626-9750

11 Washington Place, Bedford, NH 03110

BASC Imaging

(603) 296-0723 / Fax: (603) 232-0056

20 Washington Place, Bedford, NH 03110

BASC Eye Institute

(603) 623-2020 / Fax: (603) 623-2025

11 Washington Place, Bedford, NH 03110