PATIENT SURVEY

Thank you for giving us the opportunity to serve you. We appreciate your feedback and are committed to listening to our customers.

Name
Email
Device Serial #
Phone

Rate our service level and your experience using the monitor and its accessories

General satisfaction with Preventice Services
Ability to get through on the phone
Explanations given to hook up your monitor
Amount of time the representative spent with you
Printed instruction manual included in your box
Setting up the monitor
Wearing and charging the monitor
Shipment of supplies for the length of your study
Additional Comments:
I here by authorize Preventice Solutions, Inc. to use, reuse, publish or republish my name in light of any communication I made and photographic likeness in all forms and all media for advertising, marketing, and any other lawful purposes. I release and discharge Preventice Solutions, Inc. from any and all claims and demands that may arise out of or in connection with the use of photographs, name or likeness, including without limitation any and all claims for libel or violation of any right of publicity or privacy. I have read this release and fully understand its contents, and I reserve the right to revoke this release upon written request to: Preventice Solutions, Inc.
I want to share my experience, but do not want it posted online or used.