SATISFACTION SURVEY

Performance Home Medical appreciates the opportunity to serve you.  We hope you are, and will continue to be, completely satisfied with our products and services.

In order to maintain our high standards, we ask you to take a few minutes to complete this survey and submit it to us by pressing the SEND button below.  Your feedback is valued and appreciated.  If you would like someone to call you, please provide your name and number at the bottom of the survey.  Thank you. 

Allen Clark, President/CEO

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1.  Was our equipment provided in clean and working order?

Yes           No           Doesn’t Apply

2.  Do you feel you received adequate instruction by the person who provided you with the equipment?

Yes           No           Doesn’t Apply

3.  Were our representatives courteous, friendly and helpful?

Yes           No           Doesn’t Apply

4.  Did you receive a copy of our billing and collection policies?

Yes           No           Doesn’t Apply

5.  Were your rights and responsibilities as a patient explained to your satisfaction?

Yes           No           Doesn’t Apply

6.  Was your set up scheduled and equipment delivered in a prompt and timely manner?

Yes           No           Doesn’t Apply

7.  Do you have our phone number and hours of business?

Yes           No           Doesn’t Apply

8.  Was it explained how to contact us after hours in the event you experience equipment failure that requires emergency service?

Yes           No           Doesn’t Apply

9.  Would you recommend us to your physician, family and friends?
Yes           No           Doesn’t Apply

10.  Overall how would you rate your experience with Performance Home Medical?
Excellent           Satisfactory           Poor


Thank you for your comments.
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