Brook Miller | Disability Aids | Stairlifts | Wheelchairs | Scooters | Electric Beds

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What is your overall satisfaction rating with our company?

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How likely are you to recommend our products to a friend or colleague?

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Please rate your level of satisfaction with your sales representative in the following areas

Very Satisfied | Satisfied | Neither | Dissatisfied | Very Dissatisfied

Initial Contact

Presentation

Understanding of your needs

Knowledge of products

If you have any additional comments about how we can improve your satisfaction with our products and services, please fill them in here

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Full Name
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Email Address
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Phone
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What is your overall satisfaction rating with our company?	Very Satisfied Satisfied Neither Dissatisfied Very Dissatisfied
Please tell us why you feel this way
please enter your reasoning
How likely are you to recommend our products to a friend or colleague?	Very Likely Likely Neither Unlikely Very Unlikely
Please tell us why you feel this way
please enter your reasoning
Please rate your level of satisfaction with your sales representative in the following areas	Very Satisfied \| Satisfied \| Neither \| Dissatisfied \| Very Dissatisfied
Initial Contact
Presentation
Understanding of your needs
Knowledge of products
If you have any additional comments about how we can improve your satisfaction with our products and services, please fill them in here	Optional
May we contact you about any of your responses?	Yes No

Customer Satisfaction Form