Customer Satisfaction Survey

Name of Hospital / Facility *

About the Product:

About the Product:

• Consumables
• Equipment
• Service

Type of Equipment:

• EMG/EP
• EEG
• IONM

Have you used the product before?

• Yes
• No

Your Experience:

How did you rate the Customer Service?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

How well did we understand your requirements?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

Product Feedback:

How would you rate the condition of the product?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

How would you rate the support provided?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

How would you rate the product performance?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

How does this equipment meet your protocols/clinical standards?

• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied

The next section uses the following categories, please respond to each question with only one response.

Would you use the product again?

• Very Likely
• Likely
• Unlikely
• Very unlikely

Would you recommend the product to a colleague?

• Very Likely
• Likely
• Unlikely
• Very unlikely

Additional Comments:

Do you wish to be contacted regarding your feedback? *

• Yes
• No

How would you like us to contact you?

• Email
• Telephone

Your email address:

Your Telephone Number

Custom Captcha *

=

Submit