LABORATORY SERVICE FEEDBACK FORM

Please rate the Laboratory services for the period …………………………………… form
a scale of 0 to 5

(1-Poor, 2- Average, 3- Good, 4-Very good, 5-Excellent)

Please circle any one:

Promptness of Issue of reports 1 2 3 4 5

Accuracy of reports 1 2 3 4 5
Communication with lab technical 1 2 3 4 5
staff
Interaction with pathologist 1 2 3 4 5
Ability of resolve issues 1 2 3 4 5
Intimation of critical results 1 2 3 4 5
Overall assessment of outsourced 1 2 3 4 5 NA*
reports
*NA –Not Applicable

Any other comments

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Name and Signature: