- Alpha Labs

Requisition Forms

Patient Satisfaction Survey

At Alpha Laboratories we continually strive to provide a timely, pleasant and comfortable experience for our patients. Your feedback is very important to us. Please take a moment to complete the information below.

Date of visit:

Name (optional):

Patient Service Centre:

1. Please select the rating for each question below:

	Poor	Fair	Good	Very Good	Excellent
Wait time
Staff courteousness
Skill of phlebotomist taking your blood
Cleanliness of facility
Was our facility easy to find
Hours of operation
Respect for your privacy
What was the overall level of care you received during your visit?

2. Would you recommend Alpha Laboratories to your family and friends?

Yes

Comments

3. What did you like most about your visit?

4. How can we improve your patient experience?

5. Please provide your contact information should you wish to be contacted

Email:

Telephone:

Thank you for completing our survey!

We truly value the information you have provided and your responses are vital in helping us to continue to provide the highest standards of excellence in patient care.