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<div align="lings"><b>DATI GENERALI</b></div></font>
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<td bgcolor="#F0F8FF" width="4%"><center>1.</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">Sesso: </span></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">M</span></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">F</span></td>
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<td bgcolor="" width="4%"><center>2.</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">Età: </span></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">da 18 a 35 anni</span></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">da 36 a 64 anni </span></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">di 65 anni</span></td>
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<font face="Italic" color="black">
<div align="lings"><b>ACCESSO AL SERVIZIO</b></div></font>
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<td bgcolor="#FFFF9B" width="4%"><center>3.</center></td>
<td><font face="Batang" size="1" bgcolor="#FFFF9B" width="4%">É la prima volta che utilizza questo servizio di Laboratorio Analisi? </font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">SI</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">NO</font></td>
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<td bgcolor="" width="4%"><center>4.</center></td>
<td><font face="Batang" size="1">Come valuta la disponibilità dei parcheggi? </font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>5.</center></td>
<td> <font face="Batang" size="1">Come valuta la cortesia e la gentilezza del personale addetto all’accettazione?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>6.</center>
<td> <font face="Batang" size="1">- Come valuta il tempo di attesa per l’accettazione?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Lungo</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Adeguato</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Breve</font></td>
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<font face="Italic" color="black">
<div align="lings"><b>ESECUZIONE DEL PRELIEVO</b></div></font>
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<td bgcolor="#FFFF9B" width="4%"><center>7.</center></td>
<td> <font face="Batang" size="1">- Come valuta la confortevolezza(posti a sedere,pulizia,etc) della sala di attesa?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>8.</center></td>
<td><font face="Batang" size="1">Se sono stati utilizzati i servizi igienici, come valuta la disponibilità e la pulizia degli stessi?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>9.</center></td>
<td> <font face="Batang" size="1">- Come valuta la profesionalità e la cortesia del personale addetto al prelievo?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>10.</center></td>
<td> <font face="Batang" size="1">- Quanto tempo ha dovuto aspettare tra l’accettazione e l’esecuzione del prelievo ?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Meno di 15 minuti</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Da 15 a 30 minui </font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Da 30 a 60 minuti</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Più di 60 minuti</font></td>
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<td bgcolor="" width="4%"><center>11.</center></td>
<td> <font face="Batang" size="1">- Come valuta il rispetto della Sua riservatezza e dignità?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<font face="Italic" color="black">
<div align="lings"><b>RITIRO DEL REFERTO</b></div></font>
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<td bgcolor="" width="4%"><center>12.</center></td>
<td> <font face="Batang" size="1">- Come valuta le informazioni ricevute dal personale , sulle modalità e sui tempi per il ritiro del referto?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>13.</center></td>
<td> <font face="Batang" size="1">- A suo giudizio, tenuto conto dei tempi tecnici ,come valuta i tempi di consegna del referto ?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Lungo</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Adeguato</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Breve</font></td>
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<font face="Italic" color="black">
<div align="lings"><b>VALUTAZIONE COMPLESSIVA </b></div></font>
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<td bgcolor="" width="4%"><center>14.</center></td>
<td> <font face="Batang" size="1">- Come valuta complessivamente il servizio ricevuto?</font></td>
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<td><center>a</center></td>
<td><font face="Batang" size="1">Insufficiente</font></td>
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<td><center>b</center></td>
<td><font face="Batang" size="1">Sufficiente</font></td>
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<td><center>c</center></td>
<td><font face="Batang" size="1">Buono</font></td>
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<td><center>d</center></td>
<td><font face="Batang" size="1">Ottimo</font></td>
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<td bgcolor="" width="4%"><center>15.</center></td>
<td> <font face="Batang" size="1">SUGGERIMENTI</font></td>
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<td><font face="Batang" size="1">________________________________________________________
____________________________________________________________</font></td>
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