Customer Survey
In order to better serve you and your patients, please take the time to fill out this survey. Our goal is to provide you with the highest quality custom fabricated devices, as well as outstanding customer service.
Company/Location
*
Practitioner Name
*
First Name
Last Name
Job# / Invoice # / PO#
*
Ship Date
*
-
Month
-
Day
Year
Date
Please Select an Item from the Drop Down Menu
*
AFO
SMO
UCB
Crow
KAFO
Leather Gauntlet
MAFO
Prosthetic Test Socket
Prosthetic Lamination
Shoe Modification
Spinal Fabrication
Upper OX
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Next
AFO, SMO, UCB Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Modification
*
1
2
3
4
5
Pulling
*
1
2
3
4
5
Trim/Finish
*
1
2
3
4
5
Pad Placement
*
1
2
3
4
5
Strap Placement
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Crow Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Modification
*
1
2
3
4
5
Pulling
*
1
2
3
4
5
Trim
*
1
2
3
4
5
Lift/Rocker
*
1
2
3
4
5
Foot Insert
*
1
2
3
4
5
Strapping
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
KAFO Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Joint Contour
*
1
2
3
4
5
Leather Work
*
1
2
3
4
5
Modification
*
1
2
3
4
5
Pull
*
1
2
3
4
5
Trim
*
1
2
3
4
5
Strapping
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Leather Gauntlet Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Modification
*
1
2
3
4
5
Pulling
*
1
2
3
4
5
Trim
*
1
2
3
4
5
Leather Work
*
1
2
3
4
5
Closure
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
MAFO Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Joint Contour
*
1
2
3
4
5
Leather Work
*
1
2
3
4
5
Shoe Work
*
1
2
3
4
5
Strapping
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Prosthetic Test Socket Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Pull Thickness
*
1
2
3
4
5
Alignment
*
1
2
3
4
5
Set Up
*
1
2
3
4
5
Trim/Buff
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Prosthetic Lamination Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Lamination
*
1
2
3
4
5
Alignment
*
1
2
3
4
5
Set Up
*
1
2
3
4
5
Trim/Buff
*
1
2
3
4
5
Cosmesis
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Shoe Modification
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Height of Lift
*
1
2
3
4
5
Instructions Followed
*
1
2
3
4
5
Overall Quality
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Spinal Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Modification
*
1
2
3
4
5
Pulling
*
1
2
3
4
5
Trim/Finish
*
1
2
3
4
5
Pad Placement
*
1
2
3
4
5
Lining
*
1
2
3
4
5
Strapping
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Back
Next
Upper OX Fabrication
Please answer the following questions:
Did you receive the product on time?
*
Yes
No
Did you receive all the supplies requested?
*
Yes
No
Please rate your overall satisfaction with the product:
*
1
2
3
4
5
Poor
WOW!
1 is Poor, 5 is WOW!
Please rate your level of satisfaction with each of the following:
Modification
*
1
2
3
4
5
Pulling
*
1
2
3
4
5
Trim/Finish
*
1
2
3
4
5
Pad Placement
*
1
2
3
4
5
Joint Placement/Contour
*
1
2
3
4
5
Strapping
*
1
2
3
4
5
Did you contact us?
*
Yes
No
Did you get a timely response?
*
Yes
No
Did you find that the people you spoke with were knowledgeable?
*
Yes
No
Was our staff pleasant to deal with?
*
Yes
No
Do you have any additional comments?
Submit
Should be Empty: