Hubs Home Oxygen Survey

Hub's Home Oxygen and Medical Supplies
Patient Satisfaction Survey
Initial Customer Survey

Was the equipment and/or supply supplied promptly?
	Excellent Good Average	Fair Poor N/A

Was the equipment and/or supply clean when received?
	Excellent Good Average	Fair Poor N/A

Does the equipment operate properly?
	Excellent Good Average	Fair Poor N/A

Were adequate instructions given for the safe use of equipment?
	Excellent Good Average	Fair Poor N/A

Was our sales staff courteous and professional during the visit?
	Excellent Good Average	Fair Poor N/A

Was our response to your questions, problems and concerns timely?
	Excellent Good Average	Fair Poor N/A

Does our business practices allow easy & understandable access to equipment, items, services, and information?
	Excellent Good Average	Fair Poor N/A

Were your financial responsibilities explained appropriately?
	Excellent Good Average	Fair Poor N/A

Did we meet your healthcare needs?
	Excellent Good Average	Fair Poor N/A

Overall, how would you rate your experience with Hub's?
	Excellent Good Average	Fair Poor N/A

What can you recomend to help improve Patient Safety on your equipment/supply?


Did the equipment/supply help reduce the pain being caused prior to your purchase/rental?


How would you rate Medicare's rules regarding home medical equipment and the impact these rules have on your access to the products and services you believe you require?


Your Name:		Hubs Location
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Date of Service		Your Email Address:
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