PATIENT SATISFACTION SURVEYPatient Name (Optional)CityStateDateREGARDING Lake Surgical SupplyServices/Equipment were provided in a timely mannerExtremely SatisfiedSatisfiedDissatisfiedExtremely Dissatisfied My home care needs were met through the services/equipment providedExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedThe staff discussed my rights and responsibilities and financial obligationsExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedThe staff informed me how to contact the office during and after hoursExtremely SatisfiedSatisfiedDissatisfiedExtremely Dissatisfied My home care needs were met through the services/equipment providedExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedI would utilize/recommend Lake Surgical Supply to my friends or familyExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedREGARDING THE STAFF OF Lake Surgical SupplyThe representatives were courteous and professionalExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedExplanations and instructions offered by representatives were adequateExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedAll procedures/services were explained prior to performing themExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedEquipment was delivered clean and in good working orderExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedMy personal property was treated with respectExtremely SatisfiedSatisfiedDissatisfiedExtremely DissatisfiedComments:SendThis field should be left blank