Patient Survey

Our HoursMon-Fri: 8:30am - 6pm Sat: 9am - 12pmContact Us(254) 968-6999Find Us2445 NW Loop Stephenville, TX 76401

Patient Survey

First Name
*

Last Name
*

Address

Phone Number

Email
*

Please rate the timely manner of your equipment delivery

Please rate your level of comfort in using and maintaining your equipment

Please rate our ability to answer your questions and our employees’ level of courteousness

Were you informed of how to contact your provider in an emergency situation after business hours?

Yes

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

Yes

Was the billing process and financial responsibilities for the equipment and/or supplies adequately explained?

Yes

How would you rate your service experience overall?

Would you like more information about our other services such as Power Mobility or Home Oxygen Therapy?

Yes

Other Comments/Suggestions

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