**CONSENT FORM AND QUESTIONNAIRE**

Etukudoh N.S. and Obeta M.U., of the Federal School of Medical Laboratory Technology (Science), Jos., would like to assess your satisfaction with the "**Federal School Diagnostic Centre**" so as to create a room for satisfaction and improvement in the services.

The survey will involve giving you a questionnaire to answer your choice in options provided or make comment where necessary. You are free to participate in this survey but if you decide not to, there is no penalty attached and this study will not in any way affect the outcome of your visit to the establishment or result for the test you requested.

All information filled in the questionnaire will be kept strictly confidential and your identity will not be disclosed.

If you accept to participate in the study, kindly sign in the space provided below;

Thank you.

Signature of participant/Date ………………………………….…………………… Signature of investigator/Date ………………………………………………………
