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Customer Service Survey

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Pensacola Fort Walton Beach Panama City  
         
Service Location  



Patient Family Member Other Caregiver  
         
Survey Completed By  



(5)
Excellent
(4)
Good
(3)
Average
(2)
Fair
(1)
Poor
N/A
Not Applicable
 
               
The equipment and/or supplies were delivered at the agreed upon time.  
               
The equipment and/or supplies were clean when delivered.  
               
The equipment operates properly.  
               
Adequate instructions were given for the safe use of the equipment.  
               
The staff was courteous and helpful.  
               
The after-hours or on-call policy was explained.  
               
I would recommend your service to my friends and family.  
               
My financial responsibilities were explained.  
               
My rights and responsibilities were explained.  
               
The products or services met my healthcare needs and expectations.  
               



Please give us suggestions to improve our services: