Patients, please tell us what you think.
At Simple Laboratories, we are passionate about patient care.

Please take a few minutes to fill out this survey about the quality of service you received. Thank you for your participation!

To enter for a chance to win a $300 Amazon gift card, please make sure to fill out your contact information at the end of this survey.
Name of the Specimen Processor / Blood Drawer who helped you *
The survey card you received at your appointment should have this info.
Clinic ID or Physician's Name *
The survey card you received at your appointment should have this info.
Date of your appointment *
MM
/
DD
/
YYYY
Time of day
Clear selection
About Your Appointment
How long did you wait to be seen by the Specimen Processor?
Clear selection
Did the Specimen Processor: *
Yes
No
Not sure
Not applicable
mention they work for Simple Laboratories
tell you when to expect your test results
explain what the lab test(s) would cost
answer questions about insurance, billing, etc.
About Your Blood Drawing Experience
Did the Specimen Processor: *
Yes
No
Not sure
Not applicable
explain the blood drawing process
answer questions about the process
make you feel comfortable / at ease during the process
About the Specimen Processor
How would you rate the overall courtesy of the Specimen Processor? *
Rude
Very courteous
How would you rate the overall competence of the Specimen Processor? *
Poor
Outstanding
Mark the boxes that characterize the demeanor of your Specimen Processor: *
Required
Additional Feedback
Would you recommend Specimen Processor to your family and friends? *
Please share any additional comments about your experience with Simple Laboratories.
Would you like either someone to contact you regarding your responses on this survey or enter to win? *
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