Your feedback is very important to us. Please take a moment to complete the survey. Thank you in advance.

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* 1. Which type of products did you receive from us? (Check all that apply)

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* 2. Is this your first time receiving a package from us?

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* 3. Did the supplies arrive in the time frame that you expected?

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* 4. Have you encountered any problems with the product(s) you were provided?

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* 5. I received instructions on the proper use of the equipment or supplies from either my health care provider or CHC Solutions, Inc.

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* 6. How would you rate the customer service representative who handled your order?

  Excellent Very Good  Good Poor Very Poor N/A
Product knowledge:
Financial responsibilities explanation:
Friendly and accommodating:

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* 7. How would you rate your overall experience with us?

  Excellent  Very Good Good  Poor Very Poor 
Rating:

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* 8. How likely is it that you would recommend CHC Solutions to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 9. Other Comments:

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* 10. Contact Information (Optional)

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