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814 Belmont St Vicksburg, MS 39180

2600 Lakeland Dr Flowood, MS 39232

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Customer Survey

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Customer Satisfaction

Patient's Name

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Date of Service

Delivery Tech

What product and services did you receive? Please check all that apply

General Medical Equipment Incontinence/Ostomy Respiratory Services Wheelchairs, Scooters, Rehab/Mobility - Repairs CPAP equipment and supplies Other Medical Equipment

Access, Delivery, and Service

Equipment/supplies were delivered in a timely manner

Yes No N/A

Equipment/supplies were ready for patient use upon delivery

Yes No N/A

Received and understood instructions on proper application and use of equipment/supplies

Yes No N/A

Feel confident to operate/use equipment/supplies

Yes No N/A

Received info on my Rights & Responsibilities, complaint process, billing, contact numbers

Yes No N/A

Response to my questions, problems, concerns were addressed in a timely manner

Yes No N/A

Satisfied with the equipment or supplies

Yes No N/A

Satisfied with the service. Would recommend to others

Yes No N/A

Additional Comments

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Contact Us

(601) 634-6363
814 Belmont St
Vicksburg, MS 39180

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Hours

M-F: 8:30 a.m. - 5:00 p.m.
Sat: Closed
Sun: Closed

Locations

814 Belmont St Vicksburg, MS 39180
(601) 634-6363

2600 Lakeland Dr Flowood, MS 39232
(601) 933-4699

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