Feedback Form
Date
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Name:
Email
example@example.com
Occupation:
Company:
Product/s:
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Rows
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
I am very satisfied with MacMed Healthcare
MacMed Healthcare products are high quality
The product purchased meets my needs/my client's needs
I am likely to purchase/recommend other products in the future
MacMed Healthcare was very responsive to my questions or concerns about their products
I am likely to recommend MacMed Healthcare to others
How did you hear about MacMed Healthcare?
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Rows
Internet/
Google
Referral
OT or Caregiver
Prior Customer
Direct Email
Facebook/
Instagram
Other
Select One
Would you like to receive further information on our product line or a specific product?
Other feedback / recommendations:
May we use your comments, name and/or details on our website/promotional literature? If Yes, we will contact you in advance.
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