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Name
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Email
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Would your prefer to:
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Renew
Schedule Equipment Pickup
Overall, how satisfied were you with the subscription / service?
Satisfied
Neutral
Unsatisfied
When would you like to have pickup by?
*
Date
Time
This is a preference only and subject to availability. If the preferred date and time selected here is unavailable, we'll pick up on the date listed on your original rental order or contact you to coordinate pick up of your equipment.
How long would your like to extend your subscription / service?
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3 Months
6 Months
12 Months
How often did you use your machine?
Often
Occasionally
Seldom
Never Used
Would you use the product / service in the future?
Probably
Not sure
Probably not
What was the primary reason for not renewing your subscription / service?
No longer need it
It didn't meet my needs
Found an alternative
Quality was less than expected
Ease of use was less than expected
Access to the service was less than expected
Customer service was less than expected
Other
If other, please specify
What could we do to improve our subscription / service?
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Customer Service is 100% Email Based. | Delivery Only*
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