Genetic Test Evaluation Questionnaire
Please complete this questionnaire to help us evaluate your recent genetic testing experience. Your feedback is valuable and will remain confidential.
Personal Information
Please provide your basic details.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Gender
Female
Male
Non-binary
Prefer not to say
Other
Genetic Test Information
Details about your genetic test.
Which genetic test did you complete?
*
Date of Genetic Test
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you receive your genetic test results?
*
In person with a healthcare professional
Online portal
Email
Mail
Other
Please rate your experience with the following aspects of your genetic test.
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Ease of sample collection
1
2
3
4
5
Clarity of instructions
6
7
8
9
10
Communication from the provider
11
12
13
14
15
Speed of receiving results
16
17
18
19
20
Clarity of results
21
22
23
24
25
How easy was it to understand your genetic test results?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How valuable do you feel the genetic test was for your personal health or knowledge?
*
1
2
3
4
5
Did you take any actions based on your genetic test results?
*
Yes
No
If yes, please specify what actions you took (e.g., lifestyle changes, consulting a healthcare professional, further testing):
Would you recommend genetic testing to others?
*
Yes
No
Not sure
Additional comments or suggestions regarding your genetic testing experience:
Submit Evaluation
Should be Empty: