Rehabilitation Device Satisfaction Survey
Please share your experience and feedback regarding your rehabilitation device to help us improve our services.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which type of rehabilitation device are you using?
*
Please Select
Prosthetic Limb
Orthotic Device
Wheelchair
Mobility Aid (e.g., cane, walker)
Therapeutic Device (e.g., TENS, CPM)
Other
How long have you been using this device?
*
Please Select
Less than 1 month
1-3 months
4-6 months
7-12 months
More than 1 year
How would you rate the following aspects of your rehabilitation device?
*
Rows
Poor
Fair
Good
Very Good
Excellent
Ease of Use
1
2
3
4
5
Comfort
6
7
8
9
10
Durability
11
12
13
14
15
Effectiveness
16
17
18
19
20
Appearance
21
22
23
24
25
How satisfied are you with the overall performance of your device?
*
1
2
3
4
5
Did you experience any issues or difficulties with the device?
*
No issues
Minor issues
Major issues
If you experienced issues, please describe them here.
Would you recommend this device to others?
*
Yes
No
Not Sure
Please share any additional comments or suggestions to help us improve our rehabilitation devices.
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Submit Survey
Should be Empty: