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SleepMed Inc. - mySleepMed for Patients - Sleep Therapy Set-Up Patient Survey




Patient First Name: *
  
Patient Last Name: *
  
Lab Site: *
  
City: *
  
State: *
  
Referring Physician: *
  
What type of sleep therapy equipment did you receive during your set-up?: *
  
How soon after your doctor ordered a unit did someone contact you about set-up of your equipment?: *
  
Did SleepMed Therapy Services schedule a convenient time for your equipment set-up?: *
  
Rate how prepared the technician was to set-up the equipment at the scheduled appointment.: *
  
Was the technician courteous and leave written instructions on the use of the equipment?: *
  
Did the technician answer all the questions you had regarding the use of the equipment?: *
  
Did the overall experience meet your needs and expectations?: *
  
Would you recommend SleepMed Therapy Services to a friend or your physician?: *
  
Were you contacted for a follow-up after you began using your equipment?: *
  
Would you recommend our sleep therapy service to others?: *
  
Comments or Service/Safety Improvement Suggestions:  
  
Testimonial:  
  
If you had a good experience with our service, please provide your testimonial. We will publish only your testimonial, city, state and date of comment if used in our publications.
 
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First Name: (you must leave this field blank)
Last Name: (you must leave this field blank)
  


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