Outpatient Surgery POP Box Survey
Please rate how useful you found each item from 1 (Not Useful) to 5 (Can't Live Without It).
(1) Not Useful
(2) Somewhat Useful
(3) Useful
(4) Essential
(5) Can't Live Without It
Did Not Use
Did Not Receive
Gauze
Tape
Adhesive Remover
Alcohol Swabs
Ice Packs
Stain Remover
Miralax
Hard Candy
Dry Shampoo
No-Rinse Body Wash
Deodorant
Lip Balm
Hand Creme
Ear Plugs
Sleep Mask
Cosmetic Bag
Hibiclens
Comments:
(your unidentifiable remarks may be used as testimonials on our site)
Your answer
Is there anything you wish we'd included?
Your answer
If provided by a facility or practice, how would addition of this product influence your likelihood to recommend them?
(1) No Change
(2) Might recommend
(3) Would recommend if asked
(4) Would tell all your friends
(5) Would advertise for them
Likelihood to Recommend Facility
If provided by a facility or practice, how would addition of this product influence your rating of them?
Decrease
No Change
Slight Increase (1-2points/10
Large Increase (3-4points/10)
Definitely 10 ('Top Box')
Rating Change
How did you find out about us?
What procedure did you use this after?
(optional; we can't identify respondents)
Your answer
Is there anything else you'd like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service