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Name *

First

Last

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Hospital / Institution

How much do you agree or disagree with the following statements? *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Anticipates and proactively delivers what we need	Anticipates and proactively delivers what we need Strongly Disagree	Anticipates and proactively delivers what we need Disagree	Anticipates and proactively delivers what we need Neutral	Anticipates and proactively delivers what we need Agree	Anticipates and proactively delivers what we need Strongly Agree
Delivers credible and useful advice and suggestions	Delivers credible and useful advice and suggestions Strongly Disagree	Delivers credible and useful advice and suggestions Disagree	Delivers credible and useful advice and suggestions Neutral	Delivers credible and useful advice and suggestions Agree	Delivers credible and useful advice and suggestions Strongly Agree
Delivers on time and follow-through as planned	Delivers on time and follow-through as planned Strongly Disagree	Delivers on time and follow-through as planned Disagree	Delivers on time and follow-through as planned Neutral	Delivers on time and follow-through as planned Agree	Delivers on time and follow-through as planned Strongly Agree
Quick at answering our queries	Quick at answering our queries Strongly Disagree	Quick at answering our queries Disagree	Quick at answering our queries Neutral	Quick at answering our queries Agree	Quick at answering our queries Strongly Agree

How do you feel about the Repair and Replacement / Support provided *

	Very Unlikely	Unlikely	Neutral	Likely	Very Likely
Knowledgeable to diagnose our technical problems	Knowledgeable to diagnose our technical problems Very Unlikely	Knowledgeable to diagnose our technical problems Unlikely	Knowledgeable to diagnose our technical problems Neutral	Knowledgeable to diagnose our technical problems Likely	Knowledgeable to diagnose our technical problems Very Likely
Technical issues are addressed quickly and positively	Technical issues are addressed quickly and positively Very Unlikely	Technical issues are addressed quickly and positively Unlikely	Technical issues are addressed quickly and positively Neutral	Technical issues are addressed quickly and positively Likely	Technical issues are addressed quickly and positively Very Likely

How Likely you are to recommend us to peers and colleagues? *

1	2	3	4	5
Item #3 1	Item #3 2	Item #3 3	Item #3 4	Item #3 5

Tell us how can we serve you better. *

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