Customer Satisfaction Survey If you have questions please call our office at 850-729-2559 Name First Last Email The equipment and/or supplies were delivered at the agreed upon time.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableThe equipment and/or supplies were clean when received.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableThe equipment and/or supplies operate properly.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableAdequate instructions were provided for safe use of equipment and/or supplies.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableOur staff was courteous and helpful.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableOur staff was knowledgeable about the equipment and/or supplies you received.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableMy financial responsibilities were appropriately explained.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableThe store front, set up rooms and bathroom were clean.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableOverall, the services I received were to my satisfaction.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableThe service(s) I received met my healthcare needs.Strongly disagreeDisagreeNeutralAgreeStrongly agreeNot ApplicableComments or ConcernsCan we share your comments and name on our website/Facebook?*YesNo
