We strive to provide service that is in a class by itself, but the real test is whether we meet your expectations. Excellence in providing home medical equipment services is our primary goal. Please help us learn how we can improve our performance. Your response will help us provide better services to our customers in the future. Thank you for taking the time to fill out this Home Care Service Survey.

* 1. What type of equipment or product did you receive:

* 2. Which Northside Oxygen & Medical Equipment location did you visit for your equipment or supplies?

* 3. Did your equipment or products arrive in a timely manner?

* 4. Was the staff courteous and knowledgeable?

* 5. Was the equipment or products you received clean and in good working order?

* 6. Were you given clear written and verbal instructions about your equipment and its safe use?

* 7. Was your portion of the cost of service, if any, explained to you?

* 8. Were your rights & responsibilities explained and provided to you in writing?

* 9. Were you informed about and provided Northside Oxygen & Medical Equipment's customer complaint process, including Joint Commission?

* 10. Were you provided Northside Oxygen & Medical Equipment's after-hours and weekend on-call process and phone number?

* 11. Overall, are you satisfied with the equipment and services provided to you?

* 12. We welcome your comments:

* 13. The following information is optional: