Home > Customer Satisfaction Survey Customer Satisfaction Survey Please mark the answer that best describes your satisfaction. Excellent — 5 | Good — 4 | Fair — 3 | Poor — 2 | Very Poor — 1 Which products and services did you receive? (check all that apply) Respiratory Equipment Rehabilitation & Mobility Medical Supplies Other Did the staff deliver and explain your Bill Of Rights Yes No Were you satisfied with the training provided to you? Yes No Were your deliveries timely? (If applicable) Yes No Please rate the courtesy/friendliness of our staff. 1 2 3 4 5 Please rate your understanding and knowledge of your financial responsibility (if any) when you received your equipment. 1 2 3 4 5 Please rate the cleanliness and working condition of your equipment when received. 1 2 3 4 5 Overall how would you rate our service 1 2 3 4 5 Name Email Phone Comments Send