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* 2. Date Completed:

Date:

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* 3. Who referred you to this laboratory?

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* 4. Please rate our services.

  Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
The staff was professional and courteous.
I did not wait longer than I thought was reasonable for my services.
All my questions were answered to my satisfaction.
I was satisfied with how my blood was drawn.
The location and hours of the service center were convenient.
The service center was clean and neat in appearance.

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* 5. My experience would have been better if:

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* 6. Would you like to speak with a laboratory representative about the services you have received?

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* 7. Please fill in your name, email and phone number if you would like to be entered to win a prize.

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* 8. Collected by JVHL?

T