Phone: (800) 545-6026
Fax:     (800) 545-6071
 

Satisfaction Survey

First Name:
 Last Name:
 Daytime Phone:
 Email Address: 

We value your opinion about our service and the products we provide so please answer the following questions:

Was the equipment delivered on time?                           Yes    No

Was the equipment clean?                                              Yes   No

Was it in good working order?                                       Yes   No

Were adequate instructions provided?                            Yes   No

Was your financial responsibility explained to you?      Yes   No

Were your patient rights & responsibilities explained?  Yes   No

Was the staff member courteous and helpful?                 Yes   No

Were you told how to contact us in case of a problem?  Yes   No

Are you satisfied with your overall experience?            Yes   No
 


Additional Comments:
 
 
 

Our Commitment:

 

We work hard to make sure you have the correct equipment, on time, and with appropriate training.

 

Please contact us immediately at

(800) 545-6026

if you more urgent questions or requests.