Date of Service
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Last 7 Digits of Your Insurance Member ID #:
Overall, how satisfied are you with you latest experience with ēlizur?
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Did our team members clearly identify themselves as ēlizur representatives?
Are you satisfied with the training you received on your new product?
Did your ēlizur representative(s) satisfactorily answer any questions you had?
Did you receive the ēlizur "Return Policy & Billing Payment Guide" brochure?
Did your ēlizur representative(s) explain the return policy associated with your device?
Do you know how to contact ēlizur with any additional questions?
Please use this space to provide any additional comments and/or feedback you may have.
You are welcome to identify any ēlizur team member who provided you with excellent service, or who unfortunately did not meet your expectations. As we are committed to ensuring your privacy, this form intentionally does not request any sensitive contact information. If you would like us to respond to any of the information you are sharing, please give us a call. Thank you.
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