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Whitehall Manufacturing Customer Feedback Survey
1.
What best describes your role?
Whitehall Representative
Whitehall Rehabilitation Distributor/Dealer
End User / Customer
Specifier
Other
2.
Personal Information
Name
Company Name (if applicable)
Project Name (if applicable)
E-mail
Phone (optional)
Address
City
State/Province
Zip/Postal Code
Country
3.
Product Type
Whirlpool/Cold Tanks
Patient Care Units
BestCare® Ligature-Resistant Products
Scrub Sinks
Dialysis Boxes
Accessories and Fixtures
Cleat Pros
Training Stairs
Other (please specify)
4.
Model or Description or Sales Order or Purchase Order Number [if known):
5.
How frequently do you use the product?
Daily
Weekly
Monthly
Rarely
This is the first time
Other (please specify)
6.
How would you rate this product? (1 = Poor, 5 = Excellent)
Poor
Needs Improvement
Fair
Good
Excellent
Poor
Needs Improvement
Fair
Good
Excellent
7.
Overall, how would you rate your experience with Whitehall Manufacturing? (1 = Poor, 5 = Excellent)
Poor
Needs Improvement
Fair
Good
Excellent
Poor
Needs Improvement
Fair
Good
Excellent
8.
General Comments
9.
Can we contact you regarding your feedback?
Yes
No
10.
Were you satisfied with the timeliness of the delivery of your product?
Yes
No