Patient Survey

Tell Us About Your Experience

Your feedback helps us keep improving. Takes about two minutes.

Which Fayette Medical Supply office provided you service? *

La Grange Bastrop Not Sure

The equipment and/or supplies were delivered on time: *

The equipment was clean when delivered: *

The equipment was in good working order when delivered: *

The instructions were adequate for safe use of the equipment: *

The staff was courteous and helpful: *

The financial responsibilities about my bill were explained to me: *

Overall the services I received were to my satisfaction: *

I would recommend your service to my friends and family: *

Overall, I would rate my health today as: *

Other Comments?

Your Name (Optional):