Patient Survey Name First Last PhoneEmail How did you hear about Diabetes Supply Center of the Midlands?*Was our phone staff courteous and polite?*YesNoNAWas our in store staff helpful and knowledgeable?*YesNoNAWhile in the store were you assisted in a timely manner?*YesNoNAIf you had your order delivered, your delivery arrived at your home within the promised time frame?*YesNoNAWere you aware of all the products and services we provide?*YesNoNADid you receive enough instruction on the use of your equipment or medication?*YesNoNAWas your order complete when your received it?*YesNoWere we able to supply all of the products/ services you need?*YesNoNAWould you recommend Diabetes Supply Center of the Midlands to family and friends?*YesNoDo you have any additional information? Would you like one of our department managers to contact you about your experience?Spam Check
