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Screening Survey

Please complete this screening survey to describe your experience with your student diagnostic medical sonography technologist. those who complete the survey receive $10 Amazon gift card for their participation in helping students excel in their ultrasound journey.

Ultrasound Student Experience Survey

Date
Month
Day
Year
Please select your student sonographer.

Please enter your email to receive your $10 Amazon gift card.

Please rate each statement using the scale below.

1. I felt comfortable during the ultrasound exam.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
2. The student clearly introduced themselves and explained the procedure.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
3. The student demonstrated professionalism. (respect, communication, demeanor)
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
4. My privacy and dignity were respected throughout the exam.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
5. The student appeared confident while performing the scan.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
6. The student reminded me to breathe after asking me to take a breathe in and hold it.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
7. The student checked in with me about my comfort during the exam.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
8. I felt safe during the ultrasound exam.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
9. I would feel comfortable being scanned by an ADOM student in the future.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
10. Overall, I am satisfied with my experience.
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree

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