SurveyMonkey Powered Online Survey

Please take this short survey regarding the laboratory services at Acton Medical Associates. Your input will help us in our continuing effort to provide excellent patient care throughout our facilities.

1. Please rate the quality of your most recent encounter with the receptionist:

	Excellent	Good	Adequate	Poor	Unacceptable
Appropriate Greeting	*Please rate the quality of your most recent encounter with the receptionist: Appropriate Greeting Excellent	Appropriate Greeting Good	Appropriate Greeting Adequate	Appropriate Greeting Poor	Appropriate Greeting Unacceptable
Greeted Promptly	Greeted Promptly Excellent	Greeted Promptly Good	Greeted Promptly Adequate	Greeted Promptly Poor	Greeted Promptly Unacceptable
Courtesy and cooperation	Courtesy and cooperation Excellent	Courtesy and cooperation Good	Courtesy and cooperation Adequate	Courtesy and cooperation Poor	Courtesy and cooperation Unacceptable
Communicating clearly and effectively	Communicating clearly and effectively Excellent	Communicating clearly and effectively Good	Communicating clearly and effectively Adequate	Communicating clearly and effectively Poor	Communicating clearly and effectively Unacceptable
Answering your questions	Answering your questions Excellent	Answering your questions Good	Answering your questions Adequate	Answering your questions Poor	Answering your questions Unacceptable
Making you feel comfortable	Making you feel comfortable Excellent	Making you feel comfortable Good	Making you feel comfortable Adequate	Making you feel comfortable Poor	Making you feel comfortable Unacceptable

2. Please rate the quality of your latest encounter with your phlebotomist (the person who drew your blood):

	Excellent	Good	Adequate	Poor	Unacceptable
Appropriate greeting	*Please rate the quality of your latest encounter with your phlebotomist (the person who drew your blood): Appropriate greeting Excellent	Appropriate greeting Good	Appropriate greeting Adequate	Appropriate greeting Poor	Appropriate greeting Unacceptable
Courtesy and cooperation	Courtesy and cooperation Excellent	Courtesy and cooperation Good	Courtesy and cooperation Adequate	Courtesy and cooperation Poor	Courtesy and cooperation Unacceptable
Communicating clearly and effectively	Communicating clearly and effectively Excellent	Communicating clearly and effectively Good	Communicating clearly and effectively Adequate	Communicating clearly and effectively Poor	Communicating clearly and effectively Unacceptable
Making you feel comfortable	Making you feel comfortable Excellent	Making you feel comfortable Good	Making you feel comfortable Adequate	Making you feel comfortable Poor	Making you feel comfortable Unacceptable
Phlebotomy skills	Phlebotomy skills Excellent	Phlebotomy skills Good	Phlebotomy skills Adequate	Phlebotomy skills Poor	Phlebotomy skills Unacceptable

3. For your most recent encounter, how long did you have to wait before being seen?

For your most recent encounter, how long did you have to wait before being seen? I was seen promptly

5 to 10 minutes

15 to 20 minutes

More that 20 minutes

More than 30 minutes

4. Please rate the quality of the laboratory surroundings:

	Excellent	Good	Adequate	Poor	Unacceptable
Waiting Area	*Please rate the quality of the laboratory surroundings: Waiting Area Excellent	Waiting Area Good	Waiting Area Adequate	Waiting Area Poor	Waiting Area Unacceptable
Phlebotomy Room	Phlebotomy Room Excellent	Phlebotomy Room Good	Phlebotomy Room Adequate	Phlebotomy Room Poor	Phlebotomy Room Unacceptable
Bathroom	Bathroom Excellent	Bathroom Good	Bathroom Adequate	Bathroom Poor	Bathroom Unacceptable

5. How satisfied are you with the following aspects of making an appointment with the lab?

	Excellent	Good	Adequate	Poor	Unacceptable
Call answer time	*How satisfied are you with the following aspects of making an appointment with the lab? Call answer time Excellent	Call answer time Good	Call answer time Adequate	Call answer time Poor	Call answer time Unacceptable
Call wait time	Call wait time Excellent	Call wait time Good	Call wait time Adequate	Call wait time Poor	Call wait time Unacceptable
Getting the appointment time you wanted	Getting the appointment time you wanted Excellent	Getting the appointment time you wanted Good	Getting the appointment time you wanted Adequate	Getting the appointment time you wanted Poor	Getting the appointment time you wanted Unacceptable

6. When was your last visit to the AMA laboratory?

	MM		DD		YYYY		HH		MM	AM/PM
Date/Time	When was your last visit to the AMA laboratory? Date/Time Month	/	Day	/	Year		Hour	:	Minute	AM or PM

7. Acton Medical is interested in your feedback, please make any additional comments or suggestions here.

Acton Medical is interested in your feedback, please make any additional comments or suggestions here.

AMA, PC Laboratory Services Survey