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Customer Survey

Please check the space that best describes your experiences with Pain Rehab Products, Inc. and the instruction of your medical equipment.

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1  Equipment

2  Rate your service

3  Comments

4  Contact info

• Which piece(s) of equipment did Pain Rehab Products, Inc.’s personnel supply / install for you?
  • TENS unit
  • Back Brace
  • Knee Brace

• OUR STAFF - 1: least satisified to 5: most satisfied

• Care and concern for you as a patient
  • 1
  • 2
  • 3
  • 4
  • 5
• Staff technical proficiency
  • 1
  • 2
  • 3
  • 4
  • 5
• Promptness/ efficiency
  • 1
  • 2
  • 3
  • 4
  • 5
• Appearance of personnel
  • 1
  • 2
  • 3
  • 4
  • 5

• EQUIPMENT FEATURES - 1: least satisified to 5: most satisfied

• Thorough in-service of equipment
  • 1
  • 2
  • 3
  • 4
  • 5
• Cleanliness of equipment
  • 1
  • 2
  • 3
  • 4
  • 5
• Ease of use (is the equipment easy to use)
  • 1
  • 2
  • 3
  • 4
  • 5

• HOW WE MEASURE UP - 1: least satisified to 5: most satisfied

• Your overall impression of Pain Rehab Products, Inc
  • 1
  • 2
  • 3
  • 4
  • 5
• Overall warmth/ concern of our staff
  • 1
  • 2
  • 3
  • 4
  • 5

• What did you like most about Pain Rehab Products, Inc.?
• What can we do to improve future visits?

• To enable us to respond to your comments, please include the following information:

• Date of Service
  Date Format: MM slash DD slash YYYY
• Name
  First Last
• Phone
• Email
• Age
• Sex
  • Male
  • Female
• CAPTCHA