This survey is only for clients who have received service and/or equipment from our HME Customer Service Staff and/or HME Delivery Technicians We are interested in your opinion of the Home Medical Equipment/Oxygen we provide to you. To help us maintain the highest level of professional care and service we request you complete the following survey. Answering the following questions will help us to evaluate and improve our service to you and all our other valued customers. Thank you for choosing Airway Oxygen.

* 1. Contact Information

* 2. The person who spoke with me to arrange for my medical needs was courteous, helpful and knowledgeable.

* 3. The equipment and/or supplies were provided in a timely manner at the agreed upon time.

* 4. The equipment and/or supplies were clean when I received them.

* 5. Adequate instruction regarding the safe use and care of the equipment/supplies was provided.

* 6. The person providing the instruction was courteous, helpful and knowledgeable.

* 7. My financial responsibilities were explained to me.

* 8. The equipment/supplies provided operated as expected and adequately met my healthcare needs.

* 9. Overall, I was pleased with the equipment/supplies and services provided to me.

* 10. I would recommend the services from Airway Oxygen to a friend or family member