Patient Survey Name First Last PhoneEmail How did you hear about Diabetes Supply Center of the Midlands?* Was our phone staff courteous and polite?* Yes No NA Was our in store staff helpful and knowledgeable?* Yes No NA While in the store were you assisted in a timely manner?* Yes No NA If you had your order delivered, your delivery arrived at your home within the promised time frame?* Yes No NA Were you aware of all the products and services we provide?* Yes No NA Did you receive enough instruction on the use of your equipment or medication?* Yes No NA Was your order complete when your received it?* Yes No Were we able to supply all of the products/ services you need?* Yes No NA Would you recommend Diabetes Supply Center of the Midlands to family and friends?* Yes No Do you have any additional information? Would you like one of our department managers to contact you about your experience?Spam Check
