I. Was our staff courteous, knowledgeable and professional?:

II. Were you satisfied with your care/equipment?:

III. Was the service/equipment provided in a timely manner?:

IV. Were you given complete instructions on your care/equipment?:

V. Were all your questions answered to your satisfaction?:

VI. Were you instructed on who/where to call with questions or problems?

VII. Would you recommend our services/equipment to others?:

VIII. Were you given a copy of the patient Bill of Rights and the Agreement and Consent form? Were these documents explained to you prior to signing?:

IX. Please share your comments or suggestions on how we might serve you better.: