Mark & Kambour Pathology Client Survey

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* 1. Contact Information

Name: *

Practice: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. Which of the following services do you utilize?

Cytology: Pap Smears

GI and Liver Pathology

OB/GYN Pathology

Molecular Diagnostics (HPV, CT/GC, STI Panels)

Hematopathology

Dermatopathology

Skin and Soft Tissue (SSTI) Panel

Endocrine Pathology

Renal and GU Pathology

Other (please specify)

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* 3. What is your clinical specialty?

Breast

Dermatology

Ear, Nose, and Throat

Family Practice

Gastroenterology

Hematology/Oncology

Internal Medicine

Obstetrics/Gynecology

Urology

Other (please specify)

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* 4. Please rate the following categories?

	Below Average	Average	Good	Excellent	N/A
Quality/reliability of results	Quality/reliability of results Below Average	Quality/reliability of results Average	Quality/reliability of results Good	Quality/reliability of results Excellent	Quality/reliability of results N/A
Accessibility of pathologist	Accessibility of pathologist Below Average	Accessibility of pathologist Average	Accessibility of pathologist Good	Accessibility of pathologist Excellent	Accessibility of pathologist N/A
Responsiveness of pathologist	Responsiveness of pathologist Below Average	Responsiveness of pathologist Average	Responsiveness of pathologist Good	Responsiveness of pathologist Excellent	Responsiveness of pathologist N/A
Courtesy of pathologist	Courtesy of pathologist Below Average	Courtesy of pathologist Average	Courtesy of pathologist Good	Courtesy of pathologist Excellent	Courtesy of pathologist N/A
Routine turnaround times	Routine turnaround times Below Average	Routine turnaround times Average	Routine turnaround times Good	Routine turnaround times Excellent	Routine turnaround times N/A
STAT turnaround times	STAT turnaround times Below Average	STAT turnaround times Average	STAT turnaround times Good	STAT turnaround times Excellent	STAT turnaround times N/A
Mark & Kambour Pathology requisition form	Mark & Kambour Pathology requisition form Below Average	Mark & Kambour Pathology requisition form Average	Mark & Kambour Pathology requisition form Good	Mark & Kambour Pathology requisition form Excellent	Mark & Kambour Pathology requisition form N/A
Comprehensiveness of the final report	Comprehensiveness of the final report Below Average	Comprehensiveness of the final report Average	Comprehensiveness of the final report Good	Comprehensiveness of the final report Excellent	Comprehensiveness of the final report N/A
Mode of final report transmission and receipt	Mode of final report transmission and receipt Below Average	Mode of final report transmission and receipt Average	Mode of final report transmission and receipt Good	Mode of final report transmission and receipt Excellent	Mode of final report transmission and receipt N/A
Responsiveness of patient billing staff	Responsiveness of patient billing staff Below Average	Responsiveness of patient billing staff Average	Responsiveness of patient billing staff Good	Responsiveness of patient billing staff Excellent	Responsiveness of patient billing staff N/A
Courtesy of Mark & Kambour Pathology staff	Courtesy of Mark & Kambour Pathology staff Below Average	Courtesy of Mark & Kambour Pathology staff Average	Courtesy of Mark & Kambour Pathology staff Good	Courtesy of Mark & Kambour Pathology staff Excellent	Courtesy of Mark & Kambour Pathology staff N/A
Efficiency and responsiveness of the sales representative	Efficiency and responsiveness of the sales representative Below Average	Efficiency and responsiveness of the sales representative Average	Efficiency and responsiveness of the sales representative Good	Efficiency and responsiveness of the sales representative Excellent	Efficiency and responsiveness of the sales representative N/A
Overall experience with Mark & Kambour Pathology	Overall experience with Mark & Kambour Pathology Below Average	Overall experience with Mark & Kambour Pathology Average	Overall experience with Mark & Kambour Pathology Good	Overall experience with Mark & Kambour Pathology Excellent	Overall experience with Mark & Kambour Pathology N/A

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* 5. Please provide any addtional suggestions that may improve our services.

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* 6. What do you like most about our services?

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* 7. What do you like least about our services?

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* 8. What test are you currently sending?

Surgical Pathology

Pap Smear

HPV

Chlamydia/Gonorrhea

BD Affirm

Molecular STI Testing

Bone Marrow

Flow Cytometry

Other (please specify)

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* 9. Does your office use another laboratory for your pathology services?

Yes

If Yes, please provide lab name and reason.

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* 10. How likely are you to recommend our laboratory services to other physicians?

Extremely likely

Very likely

Moderately likely

Slightly likely

Not at all likely

Comments

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* 11. This survey was completed by:

Physician

Nurse

Medical Assistant

Administrator

Other (please specify)

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

YES

If Yes, Please provide your name and contact information

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

Yes