Online Survey

Use this form to complete and submit our customer survey.  
Please indicate how you became aware of this survey in the
"comments" box below.  For example, are you a recent
customer, did you receive a direct mailing, etc.    

Check if satisfied with Smartset

Check if you find the Illustrated box
instructions helpful.

List type of Magnet

List types of MRA
procedures performed

Complete this section if you are submitting the survey in response to a gift
offer received from Topspins.  Please indicate specific offer received.

Name of Hospital or
Imaging Center

Address:

City, State, Zip

Your Name:

Your E-mail Address:

Your Phone Number:

Comments: