I Have Purchased The Following Product(s):

Manual collimator
Selectable collimator
Other collimator

(Please list additional products in text box provided below)

I would also like someone to call me:
yes no

First Name

Last Name

Middle Initial

Title

Organization

Work Phone

Fax

E-mail Address (required)

Street Address

City

State

Zip Code

Country

If you purchased your Huestis Medical equipment from a dealer, please enter the dealer's name here:

Dealer Name

If your were given a job reference number, please enter it here:

Reference Number

Please check the level of satisfaction, 1 being the lowest and 10 being the highest.

1. What would you say is your overall level of satisfaction with the dealer throughout this transaction?

1 2 3 4 5 6 7 8 9 10
Explain:

1 2 3 4 5 6 7 8 9 10
Explain:

3. Did service and sales take the time to install and explain the equipment properly?

1 2 3 4 5 6 7 8 9 10
Explain:

4. When you need to purchase more equipment, would you consider a Huestis Medical product again?

1 2 3 4 5 6 7 8 9 10
Explain:

Additional Comments or Suggestions:

Thank you for taking part in this survey. What you think about our services is very important to us. If you were pleased with the equipment purchased, we would greatly appreciate your comments on your letterhead for our wall display. If you were not satisfied with the products from Huestis Medical, we would also like to hear about that.

We can be contacted at 800-972-9222 or sales@huestis.com.
If at any time you do need to contact us about this equipment please help us identify your order by referencing your job number. Thank you for your patronage.

Best Regards,
Huestis Medical