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First Name:


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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?


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