SR Scales Medical Product Focus Survey

This information is for SR Instruments, Inc., use only.

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* 1. Which SR Scale was purchased?

Model Number:

Serial Number:

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* 2. What type of facility is the product being used in?

Hospital

Nursing Home

Outpatient/Clinic

Physicians Office

Other (please specify)

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* 3. This product is used:

Less than once a week

Once a week

More than once a week

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* 4. Please identify other scales your facility has purchased in the past:

Scale-Tronix

Detecto

Health-O-Meter

Tanita

Seca

Other (please specify)

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* 5. How did you find out about SR Scales?

Trade Show

Distributor

Referral

Website

Trade Publication (which one)

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* 6. How would you rate our Sales/Customer Service support?

Excellent

Good

Average

Fair

Poor

N/A

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* 7. How would you rate our Technical Services support?

Excellent

Good

Average

Fair

Poor

N/A

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* 8. How would you rate the condition of the packaging?

Excellent

Good

Average

Fair

Poor

N/A

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* 9. How would you rate the assembly instructions and ease of assembly of the scale?

Excellent

Good

Average

Fair

Poor

N/A

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* 10. Were all the parts included?

Yes

What was missing?

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* 11. How would you rate our company to our competitors for overall product quality?

Excellent

Good

Average

Fair

Poor

N/A

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* 12. What are your improvement suggestions for our products or service?

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* 13. What would best describe your job title/function?

Biomedical

Nursing Services

Administration

Facilities/Maintenance

Other (please specify)

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* 14. Address

Name

Company/Facility

Address

Dept/Floor

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 15. Please send me a complementary "thank you" gift to the above address.

Yes

Sorry, I must decline