1) How would you rate our service in scheduling you a convenient appointment?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

2) How would you rate the courteousness and friendliness of our office staff?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

3) How would you rate the services provided by your practitioner?  Did (s)he spend enough time with you and answer all questions to your satisfaction?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

Please provide any additional feedback regarding your experience with the practitioner:

4) How would you rate the information you received on the use, cleaning and caring for your device?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

5) How would you rate the time it took to receive your device?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

6) How would you rate the overall fit, quality and comfort of your device?

5 - Excellent

4 - Very Good

3 - Good

2 - Fair

1 - Poor

7) Would you and your family recommend our services to other patients?

Yes

No

Additional comments/questions: