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Title
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Dr.
Mr.
Mrs.
Ms.
Name
*
Address
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Street Address
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Contact Number
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Date of Testing
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(For Sample Collection at Home)
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You are coming to our laboratory since (in years)
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1
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Please rate our services with 5 being the highest and 1 being the lowest
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Timely delivery of reports
5
4
3
2
1
Clinic Timings
5
4
3
2
1
Quality of report
5
4
3
2
1
General Environment
5
4
3
2
1
Staff Behaviour
5
4
3
2
1
Report Print Quality
5
4
3
2
1
Satisfaction level of our services
5
4
3
2
1
Suggestion for further improvements