Welcome to Advanced Healthcare
 
 
Satisfaction Survey

It is very important to us that we are meeting the needs of our patients. Please fill out our survey and tell us how we are doing.

*Indicates required fields

First Name*
Last Name*
E-mail Address*
 
 

On a scale from 1-5, please rate our services.

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

1. Was the Advanced Healthcare staff professional and courteous?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

2. Was the product delivered on time?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

3. Were clear instructions provided?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

4. Were you pleased with the quality of the product?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

5. Were your financial responsibilities explained?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

6. Would you recommend Advanced Healthcare?

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
5
4
3
2
1

Additional Comments

   
 
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