The staff fully explained the following items: Please check all that apply.
equipment/services you would receive operation of equipment maintenance of equipment safety measures required paperwork and Patient Bill of Rights Please choose from the drop down list how well you agree with the following statements.
Staff made sure that your equipment worked properly.	Extremely Very Some What Not very Not at all
Staff encouraged you to ask questions and express concerns.	Extremely Very Some what Not very Not at all
Staff provided you with contact numbers.	Extremely Very Some what Not very Not at all
Overall how satisfied are you with the medical equipment service you received?	Extremely Very Some what Not very Not at all
Please select a service type. oxygen sleep center Was this your first experience with medical equipment? Yes No Did your equipment ever fail? No Yes If yes were problems corrected in a timely manner? Yes No Would you recommend Eastern Oxygen to another person? Yes No Over the last three months have you been treated for or diagnosed with any of the following. Please check all that apply: Influenza(Flu) Bronchitis TB Pneumonia Other:
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