Customer Satisfaction Survey for Rehab/Service

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. 2. The equipment was repaired promptly. 3. The technician had a professional attitude. 4. The technician who worked on my equipment was effective. 5. I received adequate explanation of the repair work. 6. I was satisfied with the quality of the repair work performed. 7. I would recommend your service to my friends and family. Comments:

I would like to be contacted about this survey.
If checked, please fill out the information below.

Your First Name:
Your Last Name:
Name of customer served (if not yourself):
Date of Service:
Phone:
Email:

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