Quest at Home patient survey

1. Overall, how satisfied or dissatisfied are you with Quest at Home?

Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

2. To what extent do you agree with the following statement: Quest at Home made it easy for me to schedule my appointment at a time that was convenient for me:

3. Did we explain the process prior to your appointment?

Yes
No

4. Was your mobile phlebotomist on time?

Yes
No

5. Please rate your level of satisfaction with Quest at Home's scheduling procedure:

6. Please rate your level of satisfaction with Quest at Home's scheduling availability:

7. Please rate your level of satisfaction with your Quest at Home visit:

8. Please rate your level of satisfaction with your phlebotomist's service and performance:

9. How would you rate the value of Quest at Home's services?

Excellent
Above average
Average
Below average
Poor
N/A - I have not used Quest at Home's services

10. How likely is it that you would recommend Quest at Home's services to a friend or colleague?

Please share any other comments you have below:

Would you like to be contacted by an ExamOne representative to discuss your experience?

Yes
No

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