(VSM) Patient Satisfaction Survey

Patient Satisfaction Survey

Quipt Home Medical continually strives to improve customer service. We ask that you please take a moment and complete this brief survey. If you had a pleasant experience we would like to hear about it or if our services were dissatisfactory, we want to know about that as well. In either case, your feedback will help us provide the highest level of service and support possible.
Name*

First NameLast Name
Product Received*
Employee Name
State of Residence*

How did we perform?*

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Communication was effective and timely.
You received your equipment/supplies in the timeframe specified by our representative.
Your equipment or supplies were clean and functioning properly.
Our employees presented themselves in a professional, courteous, and respectful manner.
We provided you with information necessary to use the equipment ordered by your physician.
You are likely to recommend this company to others.