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Pathology Laboratory Pathology Client Survey
Your highly regarded assessment allows us to continue to be the leading stewards of pathology, providing the best possible patient outcomes.
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1.
Contact Information
(Required.)
Name:
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Practice:
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Address:
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Address 2:
City/Town:
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State:
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AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
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Email Address:
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Phone Number:
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2.
Which of the following services do you utilize?
(Required.)
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?
(Required.)
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?
(Required.)
Below Average
Average
Good
Excellent
N/A
Quality/reliability of results
Below Average
Average
Good
Excellent
N/A
Accessibility of pathologist
Below Average
Average
Good
Excellent
N/A
Responsiveness of pathologist
Below Average
Average
Good
Excellent
N/A
Courtesy of pathologist
Below Average
Average
Good
Excellent
N/A
Routine turnaround times
Below Average
Average
Good
Excellent
N/A
STAT turnaround times
Below Average
Average
Good
Excellent
N/A
Pathology Laboratory requisition form
Below Average
Average
Good
Excellent
N/A
Comprehensiveness of the final report
Below Average
Average
Good
Excellent
N/A
Mode of final report transmission and receipt
Below Average
Average
Good
Excellent
N/A
Responsiveness of patient billing staff
Below Average
Average
Good
Excellent
N/A
Courtesy of Pathology Laboratory staff
Below Average
Average
Good
Excellent
N/A
Efficiency and responsiveness of the sales representative
Below Average
Average
Good
Excellent
N/A
Overall experience with Pathology Laboratory pathology
Below Average
Average
Good
Excellent
N/A
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5.
Please provide any addtional suggestions that may improve our services.
(Required.)
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6.
What do you like most about our services?
(Required.)
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7.
What do you like least about our services?
(Required.)
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8.
What test are you currently sending?
(Required.)
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?
(Required.)
Yes
No
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?
(Required.)
Extremely likely
Very likely
Moderately likely
Slightly likely
Not at all likely
Comments
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11.
This survey was completed by:
(Required.)
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?
(Required.)
YES
NO
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?
(Required.)
Yes
No
