Name *
What type of device did you receive?
How would you rate your appointment time and scheduling?
How would you rate your experience with, and knowledge of our insurance department staff?
Did our staff inform you of any expense that you may be liable for should your insurance company deny or reduce payment for services rendered to you?
Did you agree to pay for any expenses you may incur if your insurance company denies or reduces payment of your claim?
How would you rate the knowledge, care and attention that our Practitioner provided to you during your visit?
Overall, how would you rate your new device and does it meet your satisfaction?
Were you given verbal and/or written instructions on the use and care of your new device?
Were you completely satisfied with the overall experience your encountered by our Practitioners and staff during your visit?
Were you asked to call our office, or make another appointment for a follow up appointment if necessary?