Clinic Equipment Questionnaire
Please fill out the following questionnaire regarding the clinic equipment.
Clinic Name
Your Name
First Name
Last Name
Position/Title
Contact Information (Email/Phone)
example@example.com
What type of clinic do you operate?
General Practice
Dental Clinic
Physical Therapy
Pediatric Clinic
Veterinary Clinic
Other
What types of equipment do you currently use?
Diagnostic Equipment
Surgical Instruments
Therapeutic Devices
Monitoring Equipment
Rehabilitation Equipment
Other
How satisfied are you with your current equipment?
Not at all satisfied
0
1
2
3
4
Very satisfied
5
0 is Not at all satisfied, 5 is Very satisfied
What equipment do you feel is lacking in your clinic?
What is your budget for new equipment?
Do you have any specific brands or models in mind?
Any additional comments or suggestions?
Submit
Should be Empty: