Home Sales Customer Feedback Survey
Please take a moment to tell us how we did!
Patient Name
First Name
Last Name
About Your Daavlin Representative
How did you hear about Daavlin?
Please Select
Doctor
Website
Magazine Ad
National Psoriasis Foundation
Vitiligo Support International
Google Search
Facebook
Friend or Family
Insurance Company
Other
Did you use our free insurance processing service?
Yes
No
What is the name of your insurance company?
(e.g. Medicare, Anthem, etc.)
Please tell us how your Daavlin representative did:
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Knowledgeable
Courteous
Professional
Responsive
How would you rate your overall satisfaction with your Daavlin representative?
1
2
3
4
5
1 = Low, 5 = High
Why did you choose to purchase your medical device from Daavlin?
About Our In-Network DME Distributor
Sometimes Daavlin is not contracted with a particular insurance, yet we are able to help our customers gain access to their in-network insurance benefits by working together with one of our approved DME (Durable Medical Equipment) Distributors.
Did your order process through a distributor?
Yes
No
Name of Distributor
Please tell us how your distributor did:
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Knowledgeable
Courteous
Professional
Responsive
How would you rate your overall satisfaction with your distributor?
1
2
3
4
5
1 = Low, 5 = High
In your opinion, should Daavlin continue to use this distributor?
About Your Daavlin Home Product
Please select the device you received:
*
DermaPal
1 Series
4 Series
7 Series
UV Series
Aquex
SAD Light
M Series
Was the packaging and delivery of your Daavlin product satisfactory?
How would you rate your overall satisfaction with your Daavlin product?
1
2
3
4
5
1 = Low, 5 = High
Is there anything we can do to improve our products, website and/or services?
If you wish to receive a response from Daavlin about your comments or questions, please include your name, company (if applicable), phone, and email.
Submit Survey
FRM-00105 [0]
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