Evaluation Survey

25% of survey complete.
Thank you for answering this survey. It is used in part to evaluate staff and also make improvements in the program.

* 1. Your Name (Optional)

* 2. Most Recent Date of Service

Date of service

* 3. Clinician's Name or Department seen by

* 4. Your Clinician or Department seen by

  Needs Improvement Fair Average Very Good Excellent N/A
Staff knowledge and skills
Explanations of test results and recommendations
Quality of report
Timeliness of report
Staff listened and communicated well
Staff considered my input