36C24420Q0407-006.docx
DOCX document Posted
- Attached to
- Q999--Multiple Site DME (VA-20-00009700) Federal contract opportunity
- Solicitation number
- 36C24420Q0407
About this file
This document contains a sample satisfaction survey for medical equipment and services provided under a Department of Veterans Affairs contract. The survey collects feedback on timeliness of delivery, cleanliness of equipment, setup and operation, instruction adequacy, staff courtesy, availability of after-hours support, likelihood of recommendation, and whether the equipment met standards. It also includes space for comments on safety improvements and optional contact information.
The related federal contract opportunity is a solicitation issued by the VA Veterans Health Administration Veterans Integrated Service Network 4 seeking multiple site durable medical equipment with solicitation number 36C24420Q0407. The opportunity type is listed as a solicitation and interested parties are directed to the attached solicitation document for additional details.
36C24420Q0407 Attachment 5-DME Satisfaction Survey.docx
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24420Q0407-0001000.docx | DOCX document | |
| 36C24420Q0407-001.docx | DOCX document | |
| 36C24420Q0407-011.pdf | ||
| 36C24420Q0407-010.pdf | ||
| 36C24420Q0407-002.docx | DOCX document | |
| 36C24420Q0407-012.xlsx | XLSX spreadsheet | |
| 36C24420Q0407-004.docx | DOCX document | |
| 36C24420Q0407-008.pdf | ||
| 36C24420Q0407-005.docx | DOCX document | |
| 36C24420Q0407-009.pdf | ||
| 36C24420Q0407-007.docx | DOCX document | |
| 36C24420Q0407-003.docx | DOCX document |
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Text version
ATTACHMENT #5
SAMPLE DME SATISFACTION SURVEY VA SIERRA PACIFIC NETWORK
Device/Type of Service (Vendor Name) You have recently received medical equipment contracted by the Department of Veterans Affairs. It is important that we know how you feel about the service you received. Please take a moment to fill out the following questionnaire and return it to us. Thank you for your input.
Please grade us on the following measures of service.
Rating:
Excellent
Average
Poor
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
1. The equipment and/or supplies were delivered at the agreed upon time.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
2. The equipment and/or supplies were clean when delivered.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
3. The equipment was set-up so that it operated properly.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
4. Adequate instructions were given for safe use of the equipment.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
5. The staff was courteous and helpful.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
6. After-hour contact numbers were provided?
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
7. I would recommend your service to my friends and family.
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
8. Did the equipment/services you received meet your standards?
| 5 |
| 4 |
| 3 |
| 2 |
| 1 |
Please tell us how we can improve your safety regarding the equipment/therapy you received from our company:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ OPTIONAL: Please tell us how to contact you if you had a problem:
Name:___________________________________ Phone Number:____________________________
File details come from the government source that posted it. Updated .