Exam Clinic Survey

Exam Clinic Survey

1. What month did you have your physical?
January

July

February

August

March

September

April

October

May

November

June

December

2. What agency are you with? (If you are a family member list the Employees agency)
DOS

FAS

Peacecorps

FCS

DHS

BBG

USAID

OTHER

Other (please specify)

3. Why are you getting a clearance physical? (Family members status is that of the empolyee)
Pre-Employment (Foreign Service Officer)
Pre-Assignment (Civil Service)
End-Of-Assignment (Civil Service)
Contractor/PSC
Inservice (FSO)
Frequent TDY and Excursion tour assignments (Civil Service)
Separation/Retirement (FSO)
WAE
Other
LNA (Limited Non-Appointed)

4. When making your appointments in the Exam Clinic were you given clear instructions regarding your
appointments, i.e. First day is the lab day, the second day is your physical exam?
Extremely Satisfied
Satisfied
Indifferent
Dissatisfied
Other (please specify)

5. You have received a clearance from the Exam Clinic.
Can you provide us with any suggestions for improvement
for day 1 (lab day)of your visit?
Yes
No
COMMENTS;

6. You have a clearance from the Exam Clinic. Can you provide us with an
suggestions for improvement for day 2 (physical exam day) of your visit?
NO
YES
Other (please specify)

7. Was there any particular employee who showed professionalism you would like to mention?
Yes
No
Other (please specify)

8. Did the lab waiting area, bathroom, phlebotomy room appear clean?
Extremely Satisfied
Satisfied
Indifferent
Dissatisfied
Other(please specify)
Other (please specify)

9. Were you told to fast 10-12 hours and drink plenty of water before your first appointment, for your
fasting lab work?
Yes
No
Other (please specify)

10. Did you have to go to a lab more than once for additional blood tests?
Yes
No
N/A