American Seating & Mobility CUSTOMER SERVICE SATISFACTION SURVEY Was the equipment delivered at the agreed upon time? Question Title * 1. Was the equipment delivered at the agreed upon time? Yes No Was the equipment clean when received? Question Title * 2. Was the equipment clean when received? Yes No Does the equipment operate properly? Question Title * 3. Does the equipment operate properly? Yes No Were adequate instructions provided for the safe use of the equipment? Question Title * 4. Were adequate instructions provided for the safe use of the equipment? Yes No Was the time between your evaluation and the time you received your medical equipment acceptable? Question Title * 5. Was the time between your evaluation and the time you received your medical equipment acceptable? Yes No Were the hours of operation provided to you? Question Title * 6. Were the hours of operation provided to you? Yes No Was the staff courteous and helpful? Question Title * 7. Was the staff courteous and helpful? Yes No Other (please specify) Would you recommend our service to your family and friends? Question Title * 8. Would you recommend our service to your family and friends? Yes No Other (please specify) Overall, how would you rate our company? Question Title * 9. Overall, how would you rate our company? Bad Poor Average Good Excellent Bad Poor Average Good Excellent Comments Overall, satisfaction: Question Title * 10. Overall, satisfaction: Done