* 1. Date of Service

* 2. Are you an employee (donor) or an employer representative?

* 3. If not a client, how did you hear about us?

* 4. Service location:

* 5. What Drug Screening Service did you utilize?

* 6. What Education - Training or Support Services did you receive?

* 7. Did you utilize our Random Program Management Services?

* 8. Please evaluate your satisfaction with the following items during this service:

  Satisfied Somewhat Satisfied Somewhat Dissatisfied Dissatisfied N/A
How satisfied were you overall with this service?
Convenience of the location
The wait for service
Courtesy of our staff
Staff skill and knowledge
Use of safety precautions
Appearance and cleanliness of facility
Delivery of results as expected
Completion of training as expected

* 9. How can we improve our services to you and your employees?

* 10. What other services or educational seminars would you like us to offer?

* 11. Would like to tour our facility, meet our staff or further discuss our services?

We invite you to visit our web site for additional details: www.swedish.org/employerassistance

Follow us on Twitter @EMAatSwedishSEA or http://twitter.com/EMAatSwedishSEA
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