Customer Satisfaction Survey Form template
A form in the Complaints and Feedback procedure (PR06), mapped to ISO 15189:2022 clause 8.6. Fill it in whenever the task occurs. Used by the quality-management team.
FormISO 15189 · 8.6As needed
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Your LaboratoryCustomer Satisfaction Survey Form | YL-QM-FRM-06-F03 v1.0
Form: Customer Satisfaction Survey Form
Please rate your satisfaction with our laboratory services. 1=Very Dissatisfied 2=Dissatisfied 3=Neutral 4=Satisfied 5=Very Satisfied
| Service Area / Question | 1 | 2 | 3 | 4 | 5 | N/A |
|---|---|---|---|---|---|---|
| Turnaround time for routine results | ||||||
| Turnaround time for urgent results | ||||||
| Accuracy and reliability of results | ||||||
| Clarity of result reports | ||||||
| Staff communication and professionalism | ||||||
| Ease of specimen submission | ||||||
| Availability of laboratory staff for queries | ||||||
| Feedback on rejected specimens | ||||||
| Critical result notification | ||||||
| Overall satisfaction with laboratory services | ||||||
| Would you recommend our services to colleagues? | ||||||
AVERAGE SCOREauto
What we are doing well
Areas needing improvement
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed by | |||
| Reviewed by |
Shaded cells are calculated automatically.
Controlled document. Printed copies are uncontrolled unless stamped.Page 1
A4 portrait · first page · showing 13 of 13 rowsExactly as LabToolkit Pro prints it — with your logo and colours
What it records
- Service Area / Question
- 1
- 2
- 3
- 4
- 5
- N/A
Instructions on the form
- Please rate your satisfaction with our laboratory services. 1=Very Dissatisfied 2=Dissatisfied 3=Neutral 4=Satisfied 5=Very Satisfied
Sign-off
- Completed by
- Reviewed by
Related templates
- Customer Complaint Form (PR06-F01)
- Complaints Register (PR06-F02)
- Customer Survey Report (PR06-F04)
- Personnel Feedback Form (PR06-F05)
- Personnel Feedback Report (PR06-F06)
- Staff Suggestion Form (PR06-F07)
- Staff Suggestion Log (PR06-F08)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.