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

* 2. Most Recent Date of Service

Date of service
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* 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
Report a problem

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