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For each question please select the word that best describes your level of satisfaction with the listed topic.  Thank you for your time, we value your opinion.

The staff fully explained the following items:
Please check all that apply.
equipment/services you would receive
operation of equipment
maintenance of equipment
safety measures
required paperwork and Patient Bill of Rights

Please choose from the drop down list how well you agree with the following statements.


Staff made sure that your equipment worked properly.

Staff encouraged you to ask questions and express concerns.
Staff provided you with contact numbers.

Overall how satisfied are you with the medical equipment service you received?


Please select a service type.

Was this your first experience with medical equipment?

Did your equipment ever fail?

If yes were problems corrected in a timely manner?

Would you recommend Eastern Oxygen to another person?

Over the last three months have you been treated for or diagnosed with any of the following.
Please check all that apply:

Your Comments are appreciated.  All responses are confidential.  You may remain anonymous or if you would like a response please list you contact information below with your comments.  Thank You!

Please click on the submit button when the survey is complete.  Thank you!