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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.

 

Optional Identification Information

Date of Service

Service Location

Last 7 Digits of Your Insurance Member ID #:




We Hope We Exceeded Your Expectations

Overall, how satisfied are you with you latest experience with ēlizur?

Extremely SatisfiedSatisfiedDissatisfiedExtremely Dissatisfied

Did our team members clearly identify themselves as ēlizur representatives?

YesMostlyNo

Are you satisfied with the training you received on your new product?

YesMostlyNo

Did your ēlizur representative(s) satisfactorily answer any questions you had?

YesMostlyNo

Did you receive the ēlizur "Return Policy & Billing Payment Guide" brochure?

YesNo

Did your ēlizur representative(s) explain the return policy associated with your device?

YesNo

Do you know how to contact ēlizur with any additional questions?

YesNo

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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