Our goal is to provide top-notch service to our patients and your comments help us to do just that! How did you choose NEWisconsin MRI Center? Advertising RefPhys Other Please rate the following with 1 being least satisfied and 5 being most satisfied. Treated with courtesy and respect by the staff? 1 2 3 4 5 Appointment wait time? 1 2 3 4 5 Special concerns considered and attended to? 1 2 3 4 5 Overall service you received? 1 2 3 4 5 Please answer the following questions. Did you feel confidence in our ability to help your doctor diagnose your condition? Yes No Did you find our website useful? Yes No If you have had an MRI at another facility, how did your experience here compare? N/A Better Similar Worse Did you have any concerns or questions that were not answered satisfactorily?    Yes No If yes, please comment. What can we do to improve our service? Other comments? Date of scan: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010 Name (Optional): May we use your comments for training and/or marketing purposes? Yes No Would you like us to call you to discuss the service you received at NEWisconsin MRI Center? Yes No If yes, phone: Best time to call: am pm Thank you from the staff at the NEWisconsin MRI Center!