Medical Patient Survey
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1. Fairview Home Medical Equipment Sleep Therapy Survey

 

1. Name the location where you received your equipment and supplies.

2. Clinician Name

3. Patient's Gender

4. Were you greeted in a timely and courteous manner?

5. You received the information necessary to understand your sleep disorder?

6. You understand the benefits of regular nightly use of your PAP therapy?

7. Were you satisfied with the variety of products?

8. Staff responded appropriately to your concerns and answered your questions?

9. Will you continue to use Fairview Home Medical Equipment for service and products?

10. Likelihood of recommending our service to others?

11. Please include any additional thoughts you have about your experience in the space provided below.

12. If you would like to be contacted personally about your experience, include your name and contact information below.

   


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