Pay Bill Online – Grace Care LLC

Name of person completing survey [optional]:

Contact information (email and/or phone number) [optional]:

Were you the patient:

Relationship to patient:

Location seen:

Date Seen:

Product(s) given from our company by the hospital/urgent care/doctors office:

For each statement, please circle the appropriate response.

1. I was properly instructed on how to use the equipment I received

2. I am comfortable using the equipment I received.

3. I am satisfied with Grace Care LLC’s level of customer service.

4. My equipment was new and in working condition.

5. I was made aware by the medical facility that I would be billed separately by Grace Care LLC for the DME equipment I received.

6. My overall experience with Grace Care LLC was pleasant.

Additional Comments