Laboratory Quality Survey

Please complete the survey below and click "submit".

Laboratory Information
Laboratory Name:* 
Laboratory Manager:*
Address:*
City:*
State:*
Zip Code:*
Country:* 
Telephone:*
Fax:*
Email address:*

Please fill out the information for the person that completed this survey in the spaces below.

Name:*
Title:*
Address:
City:
State:
Zip Code:
Country:
Telephone:
Fax:
Email address:

Signature:*

By entering your name here and submitting your laboratory information for our Value Assignment Program, you are authorizing Quantimetrix Corporation to contact you for this purpose. We will not use your information for any other purpose. We will contact you once your information is received. Thank you.

*Denotes a required field

Analyzer(s) Used
Please list the analyzer(s) currently used in your laboratory:
Please check all assays performed in your lab:
25-hydroxyvitamin D2/25-hydroxyvitamin D3
Alcohol (Serum)
Ammonia (Serum)
Amylase (Urine)
Apolipoprotein A1 (Serum)
Apolipoprotein A2 (Serum)
Apolipoprotein B (Serum)
Apolipoprotein C2 (Serum)
Apolipoprotein C3 (Serum)
Apolipoprotein E (Serum)
Calcium (Urine)
Chloride (Serum)
Chloride (Urine)
CK-MB (Serum)
CK, Total (Serum)
Creatinine (Urine)
CRP (Serum)
Digoxin (Serum)
Direct Bilirubin (Serum)
Glucose (CSF)
 Glucose (Urine)
HbA1c
HDL (Serum)
L-Homocysteine (Serum)
Lactic Acid (CSF)
 LDH (Serum)
LDL (Serum)
LP(a) (Serum)
Magnesium (Urine)
Microalbumin (Urine)
 Myoglobin (Serum)
 NT-proBNP (Serum)
 Phosphorus (Urine)
 Potassium (Serum)
 Potassium (Urine)
 Sodium (Serum)
Sodium (Urine)
 Total 25-hydroxyvitamin D
 Total Bilirubin (Serum)
 Total Cholesterol (Serum)
 Total Protein (Urine)
 Triglyceride (Serum)
 Troponin - I (Serum)
 UCFP-TP (CSF)
 Urea Nitrogen (Urine)
 Uric Acid (Urine)
 

CLIA, COLA, DAP, CLIP Certification
Is your facility certified by any of the above agencies?
If yes, please complete the following:
Date of last inspection:
Certification number:
We will contact you for a copy of your certification upon receipt of your survey.
Is there an internal quality audit program that covers all areas of operation to verify that procedures and policies are being followed to determine the effectiveness of the
quality system?

 
Is there a procedure for receiving, reviewing, handling and storage of samples?
Are calibration records maintained for each piece of equipment or instrument?
 

Type any questions or considerations in the space below:

Thank You!