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Wufoo

Institution Name: *
Please take the time to complete the following survey. Your input is an important contribution in our effort to continually improve our service. We appreciate your business and want to make sure we meet your expectations.
General Laboratory Performance

**Please rate the following:**

Survey Scale:
1=not at all satisfied 2=slightly satisfied
3=moderately satisfied
4=very satisfied
5=extremely satisfied *
	not at all satisfied	Slightly satisfied	moderately satisfied	very satisfied	extremely satisfied
1. Service provided by the Translational Genomics Laboratory	1	2	3	4	5
2. Logistics of the sample transport	1	2	3	4	5
3. Clinical report format/appearance	1	2	3	4	5
4. Turn-around time	1	2	3	4	5
5. Interactions with laboratory employees	1	2	3	4	5

6. When you call or email with problems/questions, do you receive a satisfactory response? *
Yes No
*If no please tell us why:
7. If you have contacted the lab about problem(s), was the resolution satisfactory? *
Yes No
*If no please tell us why:
Physician-specific questions

8. If you used the consultative services offered by our laboratory, please rate the following:
(if No, proceed to question #9)
	Poor	Fair	Good	Very Good	Excellent
a. Ease and availability of these services	1	2	3	4	5
b. Quality of the service	1	2	3	4	5

9. Are you satisfied with the content of the clinical report?
Satisfied Dissatisfied*
*If dissatisfied please tell us why:
10. Please list any aspect of customer service you would like our laboratory to improve upon.
Additional Comments:
Do Not Fill This Out

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