Patient Satisfaction Survey

* - Indicates a required field

Was the equipment/service provided in a timely manner? * Yes No

Were you given complete instructions on your equipment/care? * Yes No

Were all your questions answered to your satisfaction? * Yes No

Was the staff courteous, knowledgeable and professional? * Yes No

Were you instructed on who/where to call with questions/problems? * Yes No

Would you recommend our equipment/service? * Yes No

Did you receive the patient Notice of Privacy Practices and HIPPA Consent Form? * Yes No

Were these documents explained to you? * Yes No

Please share your suggestions on how we might service you better *

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