Eneslow Patient Service Evaluation Form - Eneslow, The Foot Comfort Center

Your satisfaction with our service is important to us. Please circle the response that best meets your feelings about the following statements.

If you strongly agree with the statement, circle 5, if you agree, circle 4, if you are neutral, circle 3, if you disagree, circle 2, and if you strongly disagree, circle 1.

Please feel free to add your comments.

(required) Date:
(required) Patient's Name:
(required) 1. I was treated professionally and with courtesy.:	Strongly Disagree 1 2 3 4 5 Strongly Agree
(required) 2. I was given complete instructions on the proper use, care, and maintenance of my device(s), including any wearing schedules and pamphlets that may be appropriate:	Strongly Disagree 1 2 3 4 5 Strongly Agree
(required) 3. My devices, shoes, and/or modifications meet my expectations:	Strongly Disagree 1 2 3 4 5 Strongly Agree
(required) 4. I was told to re-contact Eneslow if there is a problem with the fit or function of my device:	Strongly Disagree 1 2 3 4 5 Strongly Agree
(required) 5. The location where you received your service:	Park Avenue South Second Avenue Little Neck
(required) Comments:
Email:


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