Customer Satisfaction Survey
Please fill out the following based on your visit
The brace/orthotics/equipment was provided in a timely manner
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
Your medical history was reviewed by the fitter
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
The staff answered your questions in easy to understand terms
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
Your insurance carrier was billed promptly
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
Your follow-up care, fitting, and/or questions were resolved quickly
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
What is your opinion of our overall performance
*
1
2
3
4
5
Unsatisfactory
Excellent
1 is Unsatisfactory, 5 is Excellent
What was the best part of your visit?
*
My fitter was knowledgable
My visit was quick and easy
I received customer service
All of the above
Other
Who helped you at your visit?
*
Jake Kinghorn
Ben McKinley
Kent Hamilton
Alicia Berggren
Melissa Stanton
Jon Keene
Other
Would you recommend Mountain Brace Systems to a friend?
*
Yes
No
Is there anything we could improve on?
Any final comments?
Optional: Contact Details
Your Name
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
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