Wheelchair Medic Consumer Survey


Thank you for taking our survey. Your input will help us to monitor our performance and to maintain the high level of service you have come to expect from Wheelchair Medic.
All fields marked with * must be completed.
  Contact Information
*  Your email address:
*  First Name:
*  Last Name:
  Contacting Us After Business Hours
*  After hours contact:

  How Are We Doing?
*  Timeliness:      
  Please select a number- 5= Good and 1= Poor
*  Courtesy of delivery or technical staff:          
    Courtesy of office staff:     
*  Technicians knowledge/skills:                    
*  Cleanliness of equipment:                    
*  Did staff answer all of your questions:       
  Did We Explain Things To You?
*  Equipment use:
*  Fall prevention:
  Do You Have Any Comments/Questions/Concerns?
    Your comments:
*  Enter the security code shown:
  Do not include spaces
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