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Radhiant Foundation
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Survey
Full Name
*
Surname
*
Driver friendliness and helpfulness
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
Mammographer professionalism and care
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
Reason
*
Reason
*
Explanation of the procedure
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
Understood when and how I will receive my results
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
Reason
*
Reason
*
How well was your privacy maintained?
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
How likely are you to recommend us to a friend or family member?
*
1 = Terrible · 2 = Poor · 3 = Neutral · 4 = Good · 5 = Excellent
0
1
2
3
4
5
Reason
*
0 / 5
Reason
*
How did you hear about us?
*
Choose one option below
Choose one option
Social Media
Friend or Family
Google Search
Doctor or Healthcare Professional
Workplace or Employer
Saw the Mobile Unit
Other
Any Comments or Feedback?
Can we contact you regarding your survey answers?
*
Yes
No
Email Address
*
Phone
*
Submit
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