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Kelso Lab Survey
Hi there, your suggestions are very important to us. Please rate our preformance.
17
Questions
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1
Waiting Room Area
Excellent
Good
Poor
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2
Greeting/Friendliness
Excellent
Good
Poor
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3
Promptness of Service
Excellent
Good
Poor
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4
Efficiency at reception desk
Excellent
Good
Poor
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5
Did you use Insurance?
Yes
No
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6
Did you have only one needle stick during your visit?
Yes
No
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7
Restroom cleanliness
Excellent
Good
Poor
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8
Staff Appearance/ID
Excellent
Good
Poor
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9
Coffee area organization
Excellent
Good
Poor
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10
Would you use Kelso Lab again?
Yes
No
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11
Would you recommend Kelso?
Yes
No
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12
Additional Comments
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13
Name
This is Optional
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14
Date of visit
/
Date
Day
Month
Year
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15
Email
THIS IS OPTIONAL
example@example.com
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16
Phone Number
THIS IS OPTIONAL
Please enter a valid phone number.
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17
You can email us at
comments@kelsolab.com
T
his survey is also on our website
www.kelsolab.com
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