"*" indicates required fieldsThank you for taking a few minutes out of your day to share your experience with us. Your feedback is incredibly valuable as we continue to improve our patient care!Name* First Last Prior to your appointment, please rate how our Office Staff performed with the following:Friendliness, professionalism, and helpfulness*ExcellentGoodAcceptableFairPoorAbility to clearly explain how the process works*ExcellentGoodAcceptableFairPoorCommunication regarding the status of your order*ExcellentGoodAcceptableFairPoorResponsiveness to questions or concerns*ExcellentGoodAcceptableFairPoorThe Office Staff reviewed my insurance benefits and out of pocket costs*Strongly agreeAgreeNeutralDisagreeStrongly disagreeWere you reminded by our team to make a follow-up appointment with your provider?* No YesWas the order taken care of in a timely manner?* No YesOn a scale of 1-10, where 1 is the lowest and 10 is the highest, how likely are you to recommend Quality DME to your family and friends?*Choose Option10987654321PhoneThis field is for validation purposes and should be left unchanged.
