Integrity is our creed...
Phone: 763.566. 
                               Customer Satisfaction is our business!

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  Commission Accredited

Customer Satisfaction Survey Form
  Use this form to let us know how we are doing. We value your opinion and look forward to helping you again.

Please read the following statements and indicate the quality of service.

5=Excellent 4=Good 3=Average 2=Fair 1=Poor N/A=Not Applicable

1. The equipment was appropriately repaired.
5 4 3 2 1 N/A

2. The equipment was repaired promptly.
5 4 3 2 1 N/A

3. The technician had a professional attitude.
5 4 3 2 1 N/A

4. The technician who worked on my equipment was effective.
5 4 3 2 1 N/A

5. I received adequate explanation of the repair work.
5 4 3 2 1 N/A

6. I was satisfied with the quality of the repair work performed.
5 4 3 2 1 N/A

7. I would recommend your service to my friends and family.
5 4 3 2 1 N/A

Comments:

Check this box if you would like to be contacted about this survey:
If checked, please fill out the information below.

Your Name:

Name of customer served (if not yourself):

Date of service:
Email:
Phone #:

      

Security Notice: The information contained in this from will be transmitted across an unsecured connection to Reliable Medical Supply, Inc. By clicking the submit button you are agreeing to release all responsibilities or liabilities of Reliable Medical Supply for lost or stolen information contained in this form. Click here for more information on our email privacy.
You can also print this page and send it through conventional mail to:
Reliable Medical Supply, Inc.
Attn: Patient Services
7111 West Broadway Avenue
Brooklyn Park, MN 55428
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