Referral Survey

Thank you, for referring your patient to Tanglewood Medical Supplies for their home medical equipment needs. We appreciate the opportunity to serve you and your patients in the community. We at Tanglewood are always trying to continually improve our delivery of services and would appreciate your feed back in order to better serve you and your patients for when you call us again.

How would you rate the Order/Intake Process? 1 Being POOR - 5 Being EXCELLENT

How would you rate the Deliver/Setup Process? 1 Being POOR - 5 Being EXCELLENT

How would you rate the knowledge & professionalism of your TMS marketing representative? 1 Being POOR - 5 Being EXCELLENT

Would you say your TMS Marketing Rep visits you:

Too Much

Adequately

Not Enough

Please update your contact information & note the best way to reach you for any follow up questions:

Full Name

First Last

Phone

Fax

Comments

Name

This field is for validation purposes and should be left unchanged.

73906

Please update your contact information & note the best way to reach you for any follow up questions:

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