HME Patient Satisfaction Survey
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Patient Satisfaction Survey

DCH Home Medical Equipment
Patient Satisfaction Survey

Thank you for choosing DCH Home Medical Equipment. You can help us to provide better service by taking time to complete this satisfaction survey.

1. What was the date your medical equipment was delivered?

	MM		DD		YYYY
Date Delivered	What was the date your medical equipment was delivered? Date Delivered Month	/	Day	/	Year

2. Are you still using the equipment?

Are you still using the equipment? Yes

HME Patient Satisfaction SurveyExit this survey

Patient Satisfaction Survey

HME Patient Satisfaction Survey
Exit this survey