Missouri State Public Health Laboratory (MSPHL) Customer Service Survey	

	Please take a few minutes to fill out the following survey to help MSPHL better serve our customers.	

1.	Which of the following customer group would best describe you?	
	 q	Local Public Health Agency	
	 q	Hospital	
	 q	Health Care Provider	
	 q	Private Laboratory	
	 q	Veterinary	
	 q	Private Citizen	
	 q	Department Health and Senior Services (DHSS) Program Staff	
	 q	State Agency (i.e. DNR, etc.)	
	 q	Other	
	Please specify:	
	___________________________________________________________________________________________________________________________________________________________________________________________	

2.	Reason for choosing MSPHL to provide your service. (Check all that apply)	
	 q	Convenience	
	 q	Cost effectiveness	
	 q	Laboratory reputation	
	 q	Ability to provide timely response	
	 q	Necessary to achieve your program objectives	
	 q	Ease of ordering test kits	
	 q	High value/ Quality of service	
	 q	Mandated by Missouri statutes	
	 q	Other 	
	Please specify:	
	___________________________________________________________	

3.	What type of testing do you utilize with MSPHL? (Check all that apply)	
	 q	STD (Syphilis, Chlamydia, HIV)	
	 q	Enteric	
	 q	Parasitology	
	 q	Special Bacteriology 	
	 q	Pertussis (Whooping Cough)	
	 q	Scabies	
	 q	Tuberculosis	
	 q	Newborn Screening (i.e. PKU test, etc.)	
	 q	Environmental Bacteriology (Private or Public water sample)	
	 q	Environmental Food	
	 q	Gastrointestinal (Norovirus)	
	 q	Virus Isolation (Flu, Rash, Mumps)	
	 q	Viral Serology (Measles, Rubella, Arbovirus, Rickettsial, West Nile)	
	 q	Hepatitis	
	 q	Rabies	
	 q	Blood Lead	
	 q	Environmental Lead 	
	 q	Chemical Water Testing	
	 q	Other	
	Please specify:	
	___________________________________________________________________________________________________________________________________________________________________________________________	

4.	Please rate your level of satisfaction with each of the following Technical Services.	
		Extremely Satisfied		Very Satisfied		Slightly Satisfied		Slightly Dissatisfied		Very Dissatisfied		Extremely Dissatisfied		
	Variety of tests offered	 q		 q		 q		 q		 q		 q		
	Clarity/usefulness of the sample collection instructions	 q		 q		 q		 q		 q		 q		
	Test request form (accessibility/understanding)	 q		 q		 q		 q		 q		 q		
	Turn-around time from submission to receipt of result reports	 q		 q		 q		 q		 q		 q		
	Quality/reliability of test results	 q		 q		 q		 q		 q		 q		
	Responsiveness to technical questions and concerns	 q		 q		 q		 q		 q		 q		
	Quality of communications with MSPHL staff	 q		 q		 q		 q		 q		 q		
	Cost effectiveness	 q		 q		 q		 q		 q		 q		

5.	Please rate your level of satisfaction with each of the following Administrative/ Support Services.	
		Extremely Satisfied		Very Satisfied		Slightly Satisfied		Slightly Dissatisfied		Very Dissatisfied		Extremely Dissatisfied		
	Knowledge of staff	 q		 q		 q		 q		 q		 q		
	Courteous and professionalism of staff	 q		 q		 q		 q		 q		 q		
	Responsiveness to questions and concerns	 q		 q		 q		 q		 q		 q		
	Resolution to a concern	 q		 q		 q		 q		 q		 q		
	Information on the MSPHL website	 q		 q		 q		 q		 q		 q		
	Ease in ordering test kits	 q		 q		 q		 q		 q		 q		
	Timeliness of receiving ordered test kits	 q		 q		 q		 q		 q		 q		
	Result reports clear and understandable	 q		 q		 q		 q		 q		 q		

6.	How do you currently receive MSPHL reports? (Check all that apply)	
	 q	Mail	
	 q	Fax	
	 q	Email	
	 q	HL7 message	
	 q	Secure Website	
	 q	Other 	
	Please specify:	
	___________________________________________________________	

7.	How would you prefer to receive MSPHL reports?	
	 q	Mail	
	 q	Fax	
	 q	Email	
	 q	HL7 message	
	 q	Secure website	
	 q	Other 	
	Please specify:	
	___________________________________________________________	

8.	How would you prefer to communicate your concerns or questions with the MSPHL?	
	 q	Telephone	
	 q	Email	
	 q	Website	
	 q	Letter correspondence 	

9.	How would you prefer to have MSPHL communicate information to you? (i.e. changes to testing algorithms, forms, etc)	
	 q	Telephone	
	 q	Email	
	 q	Website	
	 q	Letter correspondence 	
	 q	Newsletter	

10.	Do you utilize the laboratory courier services provided by the MSPHL?	
	 q	Yes	
	 q	No	

11.	What reason(s) prohibit you from using the laboratory courier services provided by the MSPHL?	
	___________________________________________________________________________________________________	

12.	Please rate your satisfaction with the laboratory courier services provided by the MSPHL.	
	 q	Extremely satisfied	
	 q	Very satisfied	
	 q	Slightly satisfied	
	 q	Slightly dissatisfied	
	 q	Very dissatisfied	
	 q	Extremely dissatisfied	
	Additional comments:	
	___________________________________________________________________________________________________	

13.	Please rate your overall experience with the services you have received from the MSPHL.	
	 q	Extremely satisfied	
	 q	Very satisfied	
	 q	Slightly satisfied	
	 q	Slightly dissatisfied	
	 q	Very dissatisfied	
	 q	Extremely dissatisfied	
	Additional comments:	
	___________________________________________________________________________________________________	

14.	Suggestions on how MSPHL can better serve you.	
	___________________________________________________________________________________________________	

	Thank you for completing the MSPHL customer satisfaction survey.
If you would like to receive a response to your comments, please provide a contact name, phone number, address and/or email.	

15.	Contact name:	
	___________________________________________________________	

16.	Phone number:	
	___________________________________________________________	

17.	Address:	
	___________________________________________________________	

18.	Email:	
	___________________________________________________________