Patient Satisfaction Survey Question Title * 1. Was the equipment delivered on time? Yes No Other (please specify) Question Title * 2. Was the equipment delivered and dispensed accurately? Yes No Other (please specify) Question Title * 3. Was the training and consulting you received effective in educating you or your caregiver on how to use the product? Yes No Other (please specify) Question Title * 4. Was our staff courteous and helpful? Yes No Other (please specify) Question Title * 5. Do you feel that your financial responsibilities were clearly explained to you? Yes No Other (please specify) Question Title * 6. Did the service or equipment you received have a positive impact on the outcome of your care or treatment? Yes No Other (please specify) Question Title * 7. Would you recommend our facility to your friends and family? Yes No Other (please specify) Question Title * 8. Did the services and equipment provided meet your needs and expectations? Yes No Other (please specify) Question Title * 9. Please enter the name of your referring provider. (Required.) Question Title * 10. Please enter your name and contact information if you would like to be contacted regarding your answers. Done