2. First Name
3. Last Name
5. Company Name
6. Case number
8. 1. How would you rate your level of satisfaction with our laboratory’s customer service

   1. Very satisfied—no improvement necessary
   2. Satisfied—needs minor improvement
   3. Dissatisfied—needs a few improvements
   4. Very dissatisfied—needs considerable improvements
9. 2. How would you rate your interactions with our laboratory’s employees?

   1. Very satisfied—always friendly and helpful, tend to go the extra mile
   2. ‰ Satisfied—mostly friendly and helpful
   3. Dissatisfied—often abrupt and appear unconcerned
   4. Very dissatisfied—unfriendly and unhelpful
11. 3. How would you rate the overall quality of your relationship with our laboratory?

    1. Excellent
    2. Good
    3. Fair
    4. Poor
12. 4. Please list one aspect of customer service you wish our laboratory would improve.
16. Physician-specific questions
18. 1. How would you rate the ease and availability of consultative services offered by our laboratory?

    1. Excellent
    2. Good
    3. Fair
    4. Poor
19. 2. How would you rate the quality of interaction you receive during consultations with our laboratory?

    1. Excellent
    2. Good
    3. Fair
    4. Poor
21. Comments
25. Nursing-specific questions
27. 1. Do you receive adequate feedback when there is a problem with a specimen?

    1. Yes
    2. No
    3. If no, please explain in comments
28. 2. Is laboratory staff available and helpful?

    1. Yes
    2. No
    3. If no, please explain in comments
30. If no please explain in more detail.
34. Outreach client-specific questions
36. 1. Please rate your level of agreement with the following statements:
38. I believe LCCO Toxicology Laboratory values my business

    1. Strongly Agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly Disagree
39. Over the past year my satisfaction with LCCO Toxicology Laboratory has increased.

    1. Strongly Agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Stronglly Disagree
40. I would recommend LCCO Toxicology Laboratory.

    1. Strongly Agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly Disagree
42. 2. Compared to your experience with other laboratory providers, LCCO Toxicology Laboratory’s customer service is:

    1. Excellent
    2. Above average
    3. Average
    4. Below average
43. Other outreach feedback
47. Any other comments or suggestions on how we can improve not covered in the above questions
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