Customer Satisfaction Survey

About your order

Date

Patient name (optional)

What did we help you with? (check all that apply)

Compression pump

Ready-to-wear garments

Custom garments

Night garments

Compression wraps

Other

1. Was your equipment and/or service provided in a timely manner?

Yes No

2. Were you given clear instructions about your equipment and its care?

Yes No

3. Were all of your questions answered to your satisfaction?

Yes No

4. Was our staff courteous, knowledgeable and professional?

Yes No

5. Were you told who to contact if you have questions or concerns?

Yes No

6. Were you satisfied with the equipment and/or services you received?

Yes No

Is there something we did particularly well?

Is there something we could improve?

Additional comments or suggestions

Would you like a customer representative to contact you about your feedback?

Yes No

If yes, best phone number

Email address (optional)

Privacy statement: All responses are confidential and used for quality improvement purposes.

Thank you for your feedback and for allowing us to participate in your care.