Q01
Message
All templatesIndustry-Specific
Lab Requisition Process Experience Survey
Measures how smoothly clinical and lab staff can submit, track, and resolve issues with lab test requisitions — covering form clarity, turnaround time, and error rates. An AI follow-up reconstructs exactly what went wrong on a recent problematic requisition instead of relying on vague complaints, giving lab operations teams concrete fixes to prioritize.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
Which best describes your role?
- Physician
- Nurse or clinical staff
- Laboratory technician
- Administrative or scheduling staff
- Other
Q03
Multiple ChoiceRequired
In the last 30 days, how often have you submitted a lab requisition?
- Daily
- A few times a week
- About once a week
- A few times a month
- Rarely or never
Q04
MatrixRequired
Rate the current lab requisition process on each of the following.
5 rows × 5 columns
- Clarity of the requisition form or order-entry screen
- Accuracy of the test codes and required fields
- Specimen labeling and collection instructions
- Turnaround time from submission to results
- Integration with your EHR or lab information system
Columns: Poor · Fair · Good · Very good · Excellent
Q05
Opinion ScaleRequired
In the last 30 days, how often has a lab requisition you submitted been rejected, delayed, or sent back for correction?
Scale: 1 – 5
Min:NeverMax:Very often
Q06
Ranking
Rank these issues from the biggest problem to the smallest in your day-to-day work with lab requisitions.
- Missing or incomplete patient information
- Illegible or unclear handwriting
- Incorrect test codes selected
- Specimen labeling errors
- Delayed turnaround time
- Duplicate or redundant orders
Drag to rank
Q07
AI Interview
Reconstruct the most recent time a lab requisition you submitted was rejected, delayed, or needed correction: what test was ordered, exactly what went wrong, and who or what caused the delay (form design, missing info, system issue, staffing). Ask what specifically would have prevented it, and if they say the process is generally smooth, probe for the one step they still find annoying or slow.
Q08
Point AllocationRequired
You have 100 points to allocate across ways to improve the lab requisition process. Give more points to what would help most.
- Staff training on the requisition process
- Better order-entry forms or software
- EHR/lab system integration improvements
- Additional lab staffing
- Standardized test code reference guides
Allocate 100 points
Q09
Number
On average, roughly how many hours pass between submitting a routine lab requisition and receiving results?
Q10
Opinion Scale
How likely are you to recommend your organization's current lab requisition process to a colleague at another facility?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q11
Multiple Choice
What type of facility do you primarily work in?
- Hospital
- Outpatient clinic
- Independent or reference lab
- Long-term care facility
- Other
- Prefer not to say
Q12
Multiple Choice
How many years have you worked in your current role?
- Less than 1 year
- 1-3 years
- 4-9 years
- 10+ years
- Prefer not to say
Q13
Message
That's everything — thank you! Your feedback goes directly into a report the lab operations team uses to fix requisition forms, turnaround times, and system integrations.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
Why this template
What this template is built to do — we found no directly comparable template from other survey tools to review.
What sets it apart
- Includes an AI follow-up interview that reconstructs exactly what happened on a respondent's most recent rejected requisition, replacing vague 'it was frustrating' complaints with a step-by-step account lab ops can act on
- Pairs a matrix rating of form clarity, turnaround, and error rates with a numeric question on actual hours-to-result and an opinion-scale on rejection frequency, so perception and objective throughput are captured side by side
- Uses ranking and a 100-point constant-sum allocation to force respondents to prioritize which fixes (form design, turnaround, communication, etc.) matter most rather than rating everything as important
- Screens by role, facility type, and tenure so lab ops can segment feedback by who is actually submitting and reworking requisitions, then rolls everything into an auto-generated report
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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