Assistive Technology of Ohio Device Demonstration Survey
Please help us improve our services by filling out the following (very brief) survey about our Device Demonstrations... Thank you!
What is your name? (optional)
Last, first
When did you undergo a device demonstration? *
day/month/year
Where did you undergo a device demonstration *
Please describe (at home, at Goodwill Rehabilitation Center, etc.)
Which area does the device demonstrated assist with? *
Please select the answer that best applies...
Required
Which category best describes you, the person that underwent the device demonstration? *
Please select the answer that best applies...
Required
Which answer best applies for your situation? *
Please select one
Required
Please let us know which response best describes your situation... *
Please select one
Required
Please let us know your level of satisfaction with our device demonstration... *
Please select one
Submit
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