Patient Survey

Your satisfaction is very important to us. Please let us know if we are doing a good job, or if there are areas where we can improve, by taking a moment to complete this short survey.

Place your completed survey in the box when you return the Replexa+ device, fax your completed survey to (480) 385-2499, or complete it below.

Name *
Name
Phone
Phone
The equipment was delivered on time. *
The equipment was delivered on time.
The equipment was clean when delivered. *
The equipment was clean when delivered.
The equipment was in good working order. *
The equipment was in good working order.
The equipment was easy to use. *
The equipment was easy to use.
The instruction was adequate for safe use. *
The instruction was adequate for safe use.
The staff was courteous and helpful. *
The staff was courteous and helpful.