Assistive Technology of Ohio Lease Survey
Please help us improve our services by taking this important (and brief) survey... Thank you!
Email address *
Which device did you lease? *
Required
What was the purpose of the leased technology? *
Please indicate the reason which best applies
Required
Which category best describes the person who borrowed the device? *
Please indicate the description which best applies
Required
Which description of need best applies in your situation? *
Please indicate the description which best applies
Required
Which of the following best describes your situation? *
Required
How would you rate your level of customer satisfaction? *
Please indicate the description which best applies
Please let us know how this service has helped you by telling us about your specific situation. (optional)
Let us know how this device will impact your life! (begin typing in box below)
Your answer
A copy of your responses will be emailed to the address you provided.
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