Referring Physician/Clinic Name*
Contact Information*
Patient Information (Optional)
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1. Sample Collection & Logistics
How would you rate the clarity and ease of our sample collection instructions?* ExcellentGoodAveragePoorNot Applicable
How would you rate the professionalism and efficiency of our phlebotomy team (if used)?* ExcellentGoodAveragePoorNot Applicable
How would you rate the speed and reliability of our sample transportation service?* ExcellentGoodAveragePoorNot Applicable
2. Test Ordering & Reporting
How easy was it to place an order for the required tests?* Very EasyEasyNeutralDifficultVery Difficult
How would you rate the turnaround time for receiving the test results?* Faster than ExpectedAs ExpectedSlower than ExpectedUnacceptably Slow
How would you rate the clarity and readability of the final test report?* ExcellentGoodAveragePoor
Was the test report easy to understand and interpret?* YesNo
3. Quality of Results
How would you rate the accuracy and reliability of the test results?* Very High ConfidenceHigh ConfidenceNeutralLow ConfidenceVery Low Confidence
How useful were the reference ranges and/or clinical interpretations provided in the report?* Very UsefulUsefulNeutralNot Useful
Have you ever had to retest due to a questionable result?* YesNo
4. Customer Service & Support
How would you rate the responsiveness and helpfulness of our customer service team?* ExcellentGoodAveragePoor
Were your questions or concerns addressed satisfactorily?* YesNo
Do you receive timely updates regarding new tests, services, or changes in procedures?* YesNo
5. Overall Experience & General Feedback
How would you rate your overall satisfaction with our laboratory services?* Very SatisfiedSatisfiedNeutralDissatisfiedVery Dissatisfied
How likely are you to continue using our services and recommend us to colleagues?* Very LikelyLikelyNeutralUnlikelyVery Unlikely
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