Cleveland Skin Pathology Client Survey

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* 1. Contact Information:

Name *

Practice *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Overall, how satisfied are you with our services?

Very Satisfied

Somewhat Satisfied

Neither Satisfied or Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Are there specific areas in which you are satisfied or dissatisfied?

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* 3. Overall, how satisfied are you with the interpretation of your pathology reports?

Very Satisfied

Somewhat Satisfied

Neither Satisfied or Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Are there specific areas in which you are satisfied or dissatisfied?

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* 4. When you call Cleveland Skin Pathology, are the pathologists available for consultation?

Always

Sometimes

Seldom

N/A

Please comment on your experience.

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* 5. Do you receive your reports in a timely fashion?

Yes

Please explain areas in which you have concerns.

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* 6. How would you rate our Customer Service?

	Very Satisfied	Somewhat Satisfied	Neither Satisfied or Dissatisfied	Somewhat Dissatisfied	Very Dissatisfied
Polite and Professional	Polite and Professional Very Satisfied	Polite and Professional Somewhat Satisfied	Polite and Professional Neither Satisfied or Dissatisfied	Polite and Professional Somewhat Dissatisfied	Polite and Professional Very Dissatisfied
Knowledgeable	Knowledgeable Very Satisfied	Knowledgeable Somewhat Satisfied	Knowledgeable Neither Satisfied or Dissatisfied	Knowledgeable Somewhat Dissatisfied	Knowledgeable Very Dissatisfied
Able to Solve Problems	Able to Solve Problems Very Satisfied	Able to Solve Problems Somewhat Satisfied	Able to Solve Problems Neither Satisfied or Dissatisfied	Able to Solve Problems Somewhat Dissatisfied	Able to Solve Problems Very Dissatisfied

Are there specific areas in which you are satisfied or dissatisfied?

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* 7. When you contact our Billing Department are you satisfied with the help and information you receive?

Yes

Please share your experience.

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* 8. How would you rate our courier service?

Very Satisfied

Somewhat Satisfied

Neither Satisfied or Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Are there specific areas in which you are satisfied or dissatisfied?

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* 9. What changes could we make to better serve you, your staff, and your patients?

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* 10. Would you like a representative to contact you to address an immediate issue?

Yes

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* 11. Do we have your permission to use your comments and Practice name on our website?

Yes