Parcus Medical, LLC: Customer Feedback Form

Question Title

* Contact Information

Contact

Facility Name

Account #

Email

Phone

Please rate us below on the following products and services: Titanium IF Screws, PEEK CF IF Screws, Titanium Anchors, PEEK CF Anchors, GFS, Traction Kit, guide Pins & Wires, Suture, and Other.

Question Title

* Product

	Poor	Below Average	Average	Above Average	Excellent	N/A
Quality	Quality Poor	Quality Below Average	Quality Average	Quality Above Average	Quality Excellent	Quality N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Performance	Performance Poor	Performance Below Average	Performance Average	Performance Above Average	Performance Excellent	Performance N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Effectiveness	Effectiveness Poor	Effectiveness Below Average	Effectiveness Average	Effectiveness Above Average	Effectiveness Excellent	Effectiveness N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Price	Price Poor	Price Below Average	Price Average	Price Above Average	Price Excellent	Price N/A
Details of Feedback: (For a specific product, please list name and/or part number)

Question Title

* Shipping

	Poor	Below Average	Average	Above Average	Excellent	N/A
Packaging	Packaging Poor	Packaging Below Average	Packaging Average	Packaging Above Average	Packaging Excellent	Packaging N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Shipping/Delivery	Shipping/Delivery Poor	Shipping/Delivery Below Average	Shipping/Delivery Average	Shipping/Delivery Above Average	Shipping/Delivery Excellent	Shipping/Delivery N/A
Details of Feedback: (For a specific product, please list name and/or part number)

Question Title

* Customer Support (Response time to...)

	Poor	Below Average	Average	Above Average	Excellent	N/A
...answer questions	...answer questions Poor	...answer questions Below Average	...answer questions Average	...answer questions Above Average	...answer questions Excellent	...answer questions N/A
Details of Feedback: (For a specific product, please list name and/or part number)
...answer/return calls	...answer/return calls Poor	...answer/return calls Below Average	...answer/return calls Average	...answer/return calls Above Average	...answer/return calls Excellent	...answer/return calls N/A
Details of Feedback: (For a specific product, please list name and/or part number)
...order processing	...order processing Poor	...order processing Below Average	...order processing Average	...order processing Above Average	...order processing Excellent	...order processing N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Friendliness of Staff	Friendliness of Staff Poor	Friendliness of Staff Below Average	Friendliness of Staff Average	Friendliness of Staff Above Average	Friendliness of Staff Excellent	Friendliness of Staff N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Representative Support	Representative Support Poor	Representative Support Below Average	Representative Support Average	Representative Support Above Average	Representative Support Excellent	Representative Support N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Engineering Support	Engineering Support Poor	Engineering Support Below Average	Engineering Support Average	Engineering Support Above Average	Engineering Support Excellent	Engineering Support N/A
Details of Feedback: (For a specific product, please list name and/or part number)

Question Title

* Billing

	Poor	Below Average	Average	Above Average	Excellent	N/A
Clarity of Invoice	Clarity of Invoice Poor	Clarity of Invoice Below Average	Clarity of Invoice Average	Clarity of Invoice Above Average	Clarity of Invoice Excellent	Clarity of Invoice N/A
Details of Feedback: (For a specific product, please list name and/or part number)
Payments and Refunds	Payments and Refunds Poor	Payments and Refunds Below Average	Payments and Refunds Average	Payments and Refunds Above Average	Payments and Refunds Excellent	Payments and Refunds N/A
Details of Feedback: (For a specific product, please list name and/or part number)

Question Title

* Comments/Suggestions