COPC MyChart is Here! Click to Learn More!

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 minutes5 - 10 minutesGreater than 15 minutes

How long did you wait before your procedure was started?

0 - 5 minutes5 - 10 minutesGreater than 15 minutes

Did the lab employee introduce themselves before starting your procedure?

YesNo

Did the lab employee put on fresh gloves?

YesNo

Did the lab employee explain the procedure?

YesNo

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

YesNo

Did the lab employee hold pressure on the puncture site?

YesNo

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

YesNo

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

ExcellentGoodFairPoor

Comments or Suggestions

Max length: 1000 characters.Character count: 0

Please call to set up an appointment.

Before We Begin

Are you a current patient at Central Ohio Primary Care?

Please Note

This form is used for COPC's New Patient Placement team to help you find a new COPC doctor. It is not intended to request an appointment for a COVID-19 vaccination. Please click here to view the latest COVID-19 updates from COPC.

Yes

Patient Information

Enter your first name, phone number, zip code, and insurance below.

First Name

Phone Number

Insurance

Zip Code

Do you have a Medicare or Medicare Advantage plan?

YesNo

Select a Preferred Date and Time

Select a preferred date and time for an appointment.

Preferred Day of Week

Monday

Tuesday

Wednesday

Thursday

Friday

No Preference

Preferred Time

Confirm Details

Please verify your details are correct.

Patient Details

Name

Phone Number

Zip Code

Insurance

Do you have a Medicare or Medicare Advantage plan?

Preferred Appointment Day

Preferred Appointment Time

Best Time to Call Day

Best Time to Call Time

Your Request Has Been Submitted

A member of our New Patient Placement team will call you within 1 business day to assist you with scheduling your appointment. Please wait for our team to contact you before arriving to your appointment. If you have questions prior to our phone call, please dial (614) 326-4646, Monday — Friday, 7:30am to 5:00pm.

Patient Details

Add Us to Your Contacts

Download our contact card below so you don’t miss our call to schedule your appointment.

For Mobile Users Tap the download button below to add us to your contacts.

Download Contact Card

For Desktop Users Scan the QR code with your mobile phone to add us to your contacts.

For Current Patients

Please call your physician's office to set up an appointment.

Provider Overview

Provider Details

View Profile

Location Details

Are You a Current Patient?

Are you a current patient at Central Ohio Primary Care?

Best Time For Us To Call You

Select a preferred time range that is most convenient for us to call you and schedule your appointment.

Preferred Day of Week

Monday

Tuesday

Wednesday

Thursday

Friday

No Preference

Preferred Time

For Current Patients

Please call this physician's office to set up an appointment.

New Patient Scheduling

New Patients can either self schedule if it an option or request an appointment and our scheduling offices will contact you.

Request an Appointment

Self Scheduling

Established Patient Scheduling

Existing patients can either schedule an appointment through MyChart or call the physicians office for scheduling.

Schedule with MyChart

Provider Overview

Provider Details

View Profile

Location Details

Careers

About

Resources

Search

Laboratory Services Survey

Tell Us How We Are Doing

Submit Your Feedback

Loading