laboratory customer feedback form

Laboratory Service Quality and Performance Assessment

Instructions for Use

• Complete all sections of this form to provide actionable insights regarding your recent experience with our diagnostic or analytical services.
• Submit the signed document via [Email Address] or upload it directly to your secure client portal.
• All feedback is treated as confidential and will be reviewed by our Quality Assurance department to improve our standard operating procedures.

Parties and Definitions

This assessment is provided by [Client Name/Organization] ("Client") to [Laboratory Name] ("Laboratory") regarding services rendered under the existing Service Agreement dated [Date of Agreement].

Operative Clauses

1. Scope of Assessment: This form covers services rendered between [Start Date] and [End Date] under Project/Reference Number [Reference Number].

2. Service Evaluation: Please rate the following categories on a scale of 1 (Poor) to 5 (Excellent):

   • Timeliness of Results: [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5
   • Accuracy of Data/Reporting: [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5
   • Clarity of Technical Documentation: [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5
   • Responsiveness of Laboratory Staff: [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5

3. Deficiency Reporting: If any service failed to meet the specifications defined in the Service Agreement, please provide a detailed description of the non-conformance: [__________].

4. Corrective Action Request: If a deficiency is noted, the Client requests the following resolution:

   • Re-testing of samples
   • Review of quality control logs
   • Formal meeting with Quality Manager
   • Other: [__________]

5. Confidentiality: Both parties agree that the information disclosed in this form is proprietary and shall be handled in accordance with the confidentiality provisions of the governing Service Agreement.

6. Governing Law: This document is governed by the laws of [State/Jurisdiction].

Signature and Acknowledgment

By signing below, the Client confirms that the information provided is accurate to the best of their knowledge and authorizes the Laboratory to initiate a quality review based on this submission.

Signature: __________ Printed Name: [] Title: [] Date: [__________]

Legal Disclaimer: This document is a general framework intended for informational purposes only and does not constitute legal advice. Please consult with qualified legal counsel to ensure compliance with jurisdiction-specific regulations, industry standards (e.g., CLIA, ISO/IEC 17025), and existing contractual obligations.