Patient First Name: * | |
Patient Last Name: * | |
Lab Site: * | |
City: * | |
State: * | |
Referring Physician: * | |
What type of sleep therapy equipment did you receive during your set-up?: * | |
How soon after your doctor ordered a unit did someone contact you about set-up of your equipment?: * | |
Did SleepMed Therapy Services schedule a convenient time for your equipment set-up?: * | |
Rate how prepared the technician was to set-up the equipment at the scheduled appointment.: * | |
Was the technician courteous and leave written instructions on the use of the equipment?: * | |
Did the technician answer all the questions you had regarding the use of the equipment?: * | |
Did the overall experience meet your needs and expectations?: * | |
Would you recommend SleepMed Therapy Services to a friend or your physician?: * | |
Were you contacted for a follow-up after you began using your equipment?: * | |
Would you recommend our sleep therapy service to others?: * | |
Comments or Service/Safety Improvement Suggestions: | |
Testimonial: |
If you had a good experience with our service, please provide your testimonial. We will publish only your testimonial, city, state and date of comment if used in our publications. |
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