Customer Satisfaction Survey

Name
First Last
Email
The equipment and/or supplies were delivered at the agreed upon time.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
The equiptment and/or supplies were clean when recieved
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
The equiptment and/or supplies operate properly
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
Adequate instructions were provided for safe use of equiptment and/or supplies.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
Our staff was couterous and helpful.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
Our staff was knowledgeable about the equiptment and/or supplies you received.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
My financial responsibilities were appropriately explained.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
The store front, set up rooms and bathroom were clean.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
Overall, the services I received were to my satisfaction.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
The service(s) I received met my healthcare needs.
Strongly disagree Disagree Neutral Agree Strongly agree Not Applicable
Comments or Concerns
Can we share you comments and name on our website/facebook?*
- Yes
- No