At JACE Systems, it is our mission to provide the best care for our patients.

Your evaluation and suggestions can help us continuously improve our company.

We thank you for your time and input.

Please provide the following contact information:

                                

Name

Street Address

Address (cont.)

City

                

State/Province

Zip/Postal Code

Home Phone

E-mail

Was the equipment/service provided in a timely manner ?

Yes No

Were you given complete instructions on your equipment/care ?

Yes No

Were all of your questions answered to your satisfaction ?

Yes No

Was the staff courteous, knowledgeable and professional ?

Yes No

Were you instructed on who/where to call with any questions or problems ?

Yes No

Were you satisfied with your equipment/service ?

Yes No

Would you recommend our equipment/service to others ?

Yes No

Would you like someone to contact you ?

Yes No

Please share your comments or suggestions on how we might serve you better.




Copyright © 2008 JACE Systems. All rights reserved.
Revised: 06/26/09