Patient Focus Group Sign Up

Patient Focus Group Sign Up

Thank you for your interest!

We want to talk to our patients to gather feedback on potential improvements to the patient experience. Your participation in the focus group is completely voluntary and in no way related to your patient record. To make sure we recruit a good mix of individuals, please answer a few basic questions about yourself.

First Name:*

Last Name:*

Contact Information:

Phone Number*

Phone

Is the above number for a mobile phone?*

Email Address*

Are you or have a ever been a patient with New Jersey Imaging Network?*

Yes, I'm a current patient

I have previously visited an New Jersey Imaging Network location

No, I have never visited an New Jersey Imaging Network location

Imaging Center(s) Visited*

Select

Overall, how satisfied are you with your experience with this facility?*

I have access to a computer with a webcam and internet access*

Age*

Gender*

Female

Male

Non-binary

Prefer not to answer

Thank you for signing up as a potential focus group participant!

We'll reach out using the contact information you provided above to match you with an upcoming session as they are scheduled. Communications will come from focusgroup@radnet.com.

Only individuals who are recruited and participate in a feedback session will be compensated. Based on space, not all individuals will be contacted.

Please reach out to focusgroup@radnet.com if you have any questions and we'll get back to you as soon as possible.

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