RT Medical Patient Satisfaction Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form to help us improve our level of Service and Care. It is our desire to provide you with the best quality services available. In order to help us maintain our high standards, please take a few moments to tell us how we are doing. Thank you!

We appreciate the opportunity to serve you!

Patient Name (optional)

Equipment Type

(please check all that apply)

Bed / Support Surface

Bed Side Commode

CPAP / BiPAP

Enteral Nutrition

Negative Pressure Wound Therapy

Oxygen

Patient Lift

Suction Machine

Walker

Wheel Chair

Ventilator

Other:

Did RT Medical deliver your equipment and/or supplies on time?

Yes

Clear selection

Did RT Medical deliver your equipment and/or supplies accurately?

Yes

Clear selection

Was the training and consultations effective in educating you or your caregiver on your service, care and therapy?

Yes

Clear selection

Educational materials and instructions were adequate to teach me or my caregiver on the product(s)?

Yes

Clear selection

Was our staff courteous and helpful?

Yes

Clear selection

Were your financial responsibilities explained in a satisfactory manner?

Yes

Clear selection

Did you receive advice or help when needed during and after office hours?

Yes

Clear selection

The services and supplies you received made a positive impact on the outcome of my care and/or therapy?

Yes

Clear selection

RT Medical's Patient Service / Care Plans improved the outcome of my care and/or therapy?

Yes

Clear selection

I would recommend your service to my friends or family?

Absolutely

Yes

Clear selection

Compliments or Complaints? Please let us know.

Thank you for allowing RT Medical to serve you!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of RT Medical. Report Abuse

Forms