Referring Practitioner Satisfaction Survey

Question Title

* 1. Approximately what % of your referrals are made to MIC?

10-20%

30-40%

50-75%

100%

Question Title

* 2. What criteria do you use when choosing a provider’s requisition?

Hours of operation

First-available appointment

Location

Other (please specify)

Question Title

* 3. Rate MIC and their current level of performance on a scale of 1-5, with 1 needing improvement 3 satisfactory and 5 outstanding.

	1	2	3	4	5
Radiologist sub-specialties/ expertise / ability to handle complex cases	Radiologist sub-specialties/ expertise / ability to handle complex cases 1	Radiologist sub-specialties/ expertise / ability to handle complex cases 2	Radiologist sub-specialties/ expertise / ability to handle complex cases 3	Radiologist sub-specialties/ expertise / ability to handle complex cases 4	Radiologist sub-specialties/ expertise / ability to handle complex cases 5
Timeliness of reporting/turn-around time	Timeliness of reporting/turn-around time 1	Timeliness of reporting/turn-around time 2	Timeliness of reporting/turn-around time 3	Timeliness of reporting/turn-around time 4	Timeliness of reporting/turn-around time 5
Accuracy of reports	Accuracy of reports 1	Accuracy of reports 2	Accuracy of reports 3	Accuracy of reports 4	Accuracy of reports 5
Quality of reports	Quality of reports 1	Quality of reports 2	Quality of reports 3	Quality of reports 4	Quality of reports 5
Availability of radiologists for consultation	Availability of radiologists for consultation 1	Availability of radiologists for consultation 2	Availability of radiologists for consultation 3	Availability of radiologists for consultation 4	Availability of radiologists for consultation 5
Radiology Innovation	Radiology Innovation 1	Radiology Innovation 2	Radiology Innovation 3	Radiology Innovation 4	Radiology Innovation 5
Overall company communications	Overall company communications 1	Overall company communications 2	Overall company communications 3	Overall company communications 4	Overall company communications 5
Service by representatives	Service by representatives 1	Service by representatives 2	Service by representatives 3	Service by representatives 4	Service by representatives 5
Education events	Education events 1	Education events 2	Education events 3	Education events 4	Education events 5

Question Title

* 4. Would you recommend a friend or colleague to MIC Medical Imaging?

Yes

Question Title

* 5. Are you aware of MIC’s appointment text message reminder service?

Yes

Question Title

* 6. Are you aware of MIC’s website? www.mic.ca

Yes

Question Title

* 7. Have you visited mic.ca?

Yes

Question Title

* 8. Are you aware of the MIC Connect portal where you can view images & reports? www.mic.ca/for-practitioners/micconnect/

Yes

Question Title

* 9. Would an online booking portal or APP increase your referrals to MIC?

Yes

Question Title

* 10. Are you aware MIC has pediatric sub-specialized radiologists?

Yes

Question Title

* 11. Would you like to be invited to our next education event? If yes, please leave contact information below.

Yes

Question Title

* 12. How would you prefer to hear about new procedures offered at MIC? If by email or text messaging please leave contact information below.

Fax memo

Mailed memo

Hand delivered memo

Text message

Question Title

* 13. How can we improve our service and value to you ?

Question Title

* 14. Would you be willing to be part of a practitioner focus group? MIC is hoping to gain a practitioner perspective on their experience with MIC Medical Imaging, with the goal of identifying what is important to practitioners, and where we can improve. Your commitment would be a 2-4 hour session at a convenient location, with a small gift in appreciation of your time and contributions.

Yes, please leave contact information below.

Question Title

* 15. MIC recognizes the importance of protecting the privacy of personal information. Our privacy policy is available at www.mic.ca/privacy-policy/

If you would like someone to address your survey responses please complete the following:

Name (First and Last)

Clinic name

Phone Number

Referring Practitioner Satisfaction Survey

MIC Referring Practitioner Satisfaction Survey

Question Title

* 1. Approximately what % of your referrals are made to MIC?

Question Title

* 2. What criteria do you use when choosing a provider’s requisition?

Question Title

* 3. Rate MIC and their current level of performance on a scale of 1-5, with 1 needing improvement 3 satisfactory and 5 outstanding.

Question Title

* 4. Would you recommend a friend or colleague to MIC Medical Imaging?

Question Title

* 5. Are you aware of MIC’s appointment text message reminder service?

Question Title

* 6. Are you aware of MIC’s website? www.mic.ca

Question Title

* 7. Have you visited mic.ca?

Question Title

* 8. Are you aware of the MIC Connect portal where you can view images & reports? www.mic.ca/for-practitioners/micconnect/

Question Title

* 9. Would an online booking portal or APP increase your referrals to MIC?

Question Title

* 10. Are you aware MIC has pediatric sub-specialized radiologists?

Question Title

* 11. Would you like to be invited to our next education event? If yes, please leave contact information below.

Question Title

* 12. How would you prefer to hear about new procedures offered at MIC? If by email or text messaging please leave contact information below.

Question Title

* 13. How can we improve our service and value to you ?

Question Title

Question Title

* 15. MIC recognizes the importance of protecting the privacy of personal information. Our privacy policy is available at www.mic.ca/privacy-policy/If you would like someone to address your survey responses please complete the following:

* 15. MIC recognizes the importance of protecting the privacy of personal information. Our privacy policy is available at www.mic.ca/privacy-policy/

If you would like someone to address your survey responses please complete the following: