Baird Respiratory Customer Opinion Survey

Which of the following equipment was delivered (Please check all the apply)? CPAP Commode Hospital Bed Wheelchair Walker Patient Lift Seat Lift Chair Orthotics Oxygen

Other

Did our Customer Service staff review your insurance benefits, including any applicable co-pays and deductibles?Yes No

If your medical equipment/supplies were delivered, did they arrive at the scheduled delivery window?Yes No

Was our personnel knowledgeable about your equipment and did their instructions answer all your questions?Yes No

Did you receive home equipment/supplies in good working order ?Yes No

A Patient's Bill of Rights & Responsibilities and a Privacy Notice is printed on the reverse side of your delivery ticket. After reviewing the information, do you have any questions regarding the notices?Yes No

Was our personnel friendly, professional and courteous? Yes No

Customer Opinion Survey

Customer Opinion Survey

FOR CPAP PATIENTS ONLY

FOR OXYGEN PATIENTS ONLY

WE APPRECIATE YOUR TIME TO COMPLETE THIS SURVEY. THANK YOU.