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First Name:

Last Name:

Date of Service:

Type of Equipment Received:

Were equipment/supplies delivered in a timely manner?

Were equipment/supplies ready for use upon delivery?

Did you receive and understand instructions on proper application and use of equipment/supplies?

Do you feel confident to operate/use equipment/supplies?

Was your customer service representative helpful and friendly?

Was your customer service representative knowledgeable?

Would you recommend Discount Medical Equipment & Supplies to a family member or friend?