Laboratory Services Survey

Tell Us How We Are Doing

Submit Your Feedback

Please take a moment to provide feedback on the lab services you received as part of your visit to a COPC Lab Draw Station. Your comments are used to improve our services.

Required fields are marked with *

Which location did you visit?

Date of Service

Would you like to be contacted about your experience?

If so, please provide name and phone number and a manager will contact you for your important feedback.

Your Name

Phone Number

How long did you wait before you were greeted by lab staff?

0 - 5 minutes

5 - 10 minutes

Greater than 15 minutes

How long did you wait before your procedure was started?

0 - 5 minutes

5 - 10 minutes

Greater than 15 minutes

Did the lab employee introduce themselves before starting your procedure?

Yes

Did the lab employee put on fresh gloves?

Yes

Did the lab employee explain the procedure?

Yes

Did the lab employee label your samples in front of you?

Yes

Did the lab employee hold pressure on the puncture site?

Yes

Did the lab employee confirm bleeding had stopped before releasing you?

Yes

Overall, how would you rate your experience in the draw station today?

Excellent

Good

Fair

Poor

Comments or Suggestions

Max length: 1000 characters.Character count: 0

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Preferred Time

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Preferred Appointment Day

Preferred Appointment Time

Best Time to Call Day

Best Time to Call Time

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Preferred Day of Week

Monday

Tuesday

Wednesday

Thursday

Friday

No Preference

Preferred Time

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Laboratory Services Survey

Tell Us How We Are Doing

Submit Your Feedback

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