0917-0036 Lab Dept Survey

FORM APPROVED

OMB Form No. xxx

Expiration Date: xxxx

xx

IHS Patient Experience of Care Survey-

Laboratory Department

Thank you for voluntarily participating in the IHS Patient Experience of Care Survey. The survey takes only a few minutes. Please select the answer that best describes your experience with the care that you received today.

Your responses and participation are kept confidential and will not be connected to you.

If you have questions or need assistance, just ask---our staff is ready to help you.

#	Question	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
1	When I arrived for my visit, I did not have to wait too long to be seen by my lab tech
2	The department staff was courteous
3	The department was clean
4	I was provided with an explanation of my procedure
5	I was given the chance to provide input or ask questions about the procedure
6	I would recommend the lab department to family and friends
7	Overall, I am satisfied with my visit

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Thank you for your time!