Go back What equipment was supplied to you? CPAP/BIPAP Machine CPAP/BIPAP Supplies Only Thank 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 patient care! * Required 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*ExcellentGoodAcceptableFairPoorTransparency about availability when scheduling a date for the CPAP Setup*ExcellentGoodAcceptableFairPoorThe Office Staff reviewed my insurance benefits and any compliance requirements.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeThe Office Staff informed me of any potential out of pocket costs.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeDid you receive education from a Respiratory Therapist?* No Yes Date of Service Appointment*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Location of Service Appointment*Choose OptionTelemedicineMy HomeMy WorkQuality DME OfficesEquipment was ShippedOtherName of your Respiratory Therapist*Choose OptionAngela IvesAnna RodriguezAntonio ShieldsBetty RockwellDenzel WrightDoris MarquinaEbbie IsraelFred BishopJanelle RolstadJason HessJesse JamesJess De La CruzJonathon SchuermannJorge TorresJulie DoellKaitlyn GraysonLynne ThormanMelinda PriceMichael HayesNick DizonNysha BarberOffice TechnicianI don't recallN/APlease rate how our Respiratory Therapist performed with the following:Outreach for appointment reminder and mask selection*ExcellentGoodAcceptableFairPoorFriendliness and professionalism with patient care*ExcellentGoodAcceptableFairPoorResponsiveness to questions during the setup process*ExcellentGoodAcceptableFairPoorExplanation of equipment and its proper application and use*ExcellentGoodAcceptableFairPoorExplanation of how to maintain equipment*ExcellentGoodAcceptableFairPoorExplanation of our long term support and follow up*ExcellentGoodAcceptableFairPoorI have a clear understanding of how to get CPAP supplies in the future.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeDid you have a Telemedicine Appointment?* No Yes Please answer the following questions about your Telemedicine experience I was well prepared and able to easily access the meeting link for my Telemedicine Appointment.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeI felt the Telemedicine Appointment was thorough and easy to follow along with clarity of equipment shown by the Respiratory Therapist.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeWould you be open to doing another Telemedicine Appointment in the future?* Yes, I enjoyed it No, I prefer Face-To-Face Appointments Were you reminded by our team to make a follow-up appointment with your provider?*Choose OptionYesNoWould you recommend Quality DME to your family and friends?*Choose OptionYesNoMaybePlease share any additional comments or suggestions belowCommentsThis field is for validation purposes and should be left unchanged. "*" indicates required fields Thank 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 patient care! * Required Name* First Last 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 explained my possible out of pocket costs.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeI have a clear understanding of how to get CPAP supplies in the future.*Strongly agreeAgreeNeutralDisagreeStrongly disagreeDo you feel you received your equipment within an acceptable time-frame?*Choose OptionYesNoMaybeWould you recommend Quality DME to your family and friends?*Choose OptionYesNoMaybePlease share any additional comments or suggestions belowEmailThis field is for validation purposes and should be left unchanged.
