Dear Customer,

Recently you received products from Elite Home Medical & Respiratory, Inc. Your opinion is very important to us. We use your feedback to improve our services and provide the best care.

Please take a few moments to complete this questionnaire. Your results will be electronically submitted to us. Thank you from The Elite Home Medical & Respiratory, Inc. Team.
0 = Very Dissatisfied
5 = Very Satisfied

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* 1. Equipment

  0 1 2 3 4 5
Was the equipment delivered in a timely manner?
Was the equipment in good operating condition?
Was the product supplied clean?

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* 2. Delivery

  0 1 2 3 4 5
Was the delivery person courteous and professional?
Did our staff provide clear operating instructions?
Did our staff satisfactorily address your questions?
Did our staff explain insurance & financial responsibility?
Was safety and emergency information presented?

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* 3. Company

  0 1 2 3 4 5
Has your experience with our company been positive?
Are you satisfied with the input you have in your care?
Would you recommend Elite Home Medical & Respiratory, Inc. to family and friends?

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* 4. Your Thoughts: