Fill in this form anonymously
Title
*
Please select
Mr
Mrs
Miss
Ms
Dr
Master
Other
Please enter your title
*
First name
*
Last name
*
Email address
*
Date of visit
Practice attended
*
--Please select--
PRP Adamstown
PRP Blacktown
PRP Blacktown - Campbell St
PRP Bathurst
PRP Brookvale
PRP Castle Hill
PRP Charlestown
PRP Cumberland
PRP Dee Why
PRP Dubbo
PRP Eastwood
PRP Erina
PRP Frenchs Forest
PRP Gordon
PRP Gosford
PRP Gosford North
PRP Hornsby
PRP Maitland
PRP Moore Park/City East
PRP Norwest
PRP Orange
PRP Shellharbour
PRP The Bond - Bella Vista
PRP Toukley
PRP Tuggerah
PRP Warriewood
PRP Westmead
PRP Wollongong
PRP Woy Woy
PRP Zetland
PRP staff name(s)
What type of examination did you have?
*
--Please select--
X-ray
Mammogram
Ultrasound
CT Scan
MRI Scan
Nuclear Medicine
PET/CT Scan
Cardiac Investigation
Other
Other examination description
*
Arrival
Ease of making appointment
--Please select--
Poor
Satisfactory
Good
Excellent
Friendliness and helpfulness of reception staff
--Please select--
Poor
Satisfactory
Good
Excellent
Reception cleanliness and comfort (furnishings and design)
--Please select--
Poor
Satisfactory
Good
Excellent
Examination
Waiting time for examination
--Please select--
Poor
Satisfactory
Good
Excellent
Explanation of your procedure
--Please select--
Poor
Satisfactory
Good
Excellent
Professionalism and friendliness of Technician
--Please select--
Poor
Satisfactory
Good
Excellent
Care and skill of Technician
--Please select--
Poor
Satisfactory
Good
Excellent
Post-examination
Processing of account
--Please select--
Poor
Satisfactory
Good
Excellent
Waiting time for results/films
--Please select--
Poor
Satisfactory
Good
Excellent
Overall experience
--Please select--
Poor
Satisfactory
Good
Excellent
How do you find the website?
--Please select--
Poor
Satisfactory
Good
Excellent
Comments or suggestions?
I consent to my data being collected and stored as per PRP's privacy policy
*
Date Stamp
Please wait, files are uploading..
Submit