Name *

First Name

Last Name

Were you contacted in a timely manner? *

Yes

No

Was the product delivered in a timely manner? *

Yes

No

Was the delivery a positive one? *

Yes

No

Were you given a copy of "HIPPA notice of privacy"? *

Yes

No

Were all of your questions and concerned answered to your satisfaction? *

Yes

No

Did the representative leave contact information in case you had questions? *

Yes

No