Customer Satisfaction Survey Select your Choices: 1 = Poor; 2 = Fair; 3 = Average; 4 = Good; 5 = Excellent 1. The equipment was delivered at the agreed upon time. 1 2 3 4 5 Comment 2. The equipment was clean when received 1 2 3 4 5 Comment 3. The equipment operates properly. 1 2 3 4 5 Comment 4. Adequate instructions were provided for the safe use of the equipment. 1 2 3 4 5 Comment 5. Our staff was helpful and courteous. 1 2 3 4 5 Comment 6. Our response to your questions, problems and concerns was timely. 1 2 3 4 5 Comment 7. Our business practices allow easy & understandable access to equipment, services and information. 1 2 3 4 5 Comment 8. Our staff provided you with a packet which included information about Pt. rights, responsibilities and privacy. 1 2 3 4 5 Comment 9. Staff gave brief explanation of what my insurance covers and what my financial responsibilities will be. 1 2 3 4 5 Comment 10. If applicable, how would you rate Medicare's rules regarding HME and how these rules affect access to products and services with the provider you choose? 1 2 3 4 5 Comment 11. What can we do to improve our service? 12. What products do we not currently carry that you would like to see offered? Name* Email Address* Phone Number City State Zip Code Comments / Complaints: Please enter the Characters and Press Send Clear Send Thank You Able Care uses your feedback to offer the Highest level of service possible! Please turn on javascript to submit your data. Thank you!