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QUALITY ASSURANCE QUESTIONNAIRE

Dear Valued Client,

Thank you for choosing The Doctors Center Mobile Health Services (DCHS) for your occupational health testing this year. Please take a moment to fill out this Quality Assurance Questionnaire in order for us to maintain, and strive to improve, our level of service for years to come. Also, if at any time you have any questions or concerns regarding any portion of the testing session, please do not hesitate to contact us immediately at the number provided below.

1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent

1. Did the DCHS Technician conduct a pre-test meeting with you to discuss all pertinent information and answer all questions to your satisfaction?

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2. Was the DCHS Technician punctual in their arrival?

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3. Was the mobile unit sanitary and at a comfortable temperature?

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4. Was the DCHS Technician professional, courteous, and efficient?

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Like any business we are always looking for opportunities to grow and expand. We appreciate any help that you can give us in doing so. If you know of any business that you would recommend our services to please provide the contact information below:

It is a pleasure doing business with you and we appreciate any and all suggestions that you can give us. If you have any other comments about our services please include them below. Thank you for choosing The Doctors Center Mobile Health Services.

Any additional comments:

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