Radiologists have always been dedicated to service and quality in imaging. In the past few years, many entities, mostly external to the profession itself, have entered the business of defining, measuring, and reporting both service and quality. There is a great deal at stake in how this unfolds, and there are many potential stakeholders in both the process and the outcome. This article addresses the perspectives of patients on service and quality issues. In particular, it is important for those in the profession to understand that their customers often view their services very differently than those within the business. The author addresses several of the most common and important perceptual issues that practitioners need to address in understanding these disparities. Success or failure will determine how satisfied patients are; how they fill out scorecards and report cards; and what they say about practitioners to their family, their neighbors, and perhaps 2 billion of their closest friends on the Web. Ultimately, how well radiologists address these issues will determine a substantial component of pay for performance, their ability to contract, and the individual decisions of patients and their families to come to them at all.