Do you currently purchase medical supplies from The Supply Center?  
Yes, online     
Yes, by phone     
No, but may in the future     
No, and no plans to do so

How did you hear about our website?
From a colleague
From a seminar or workshop
Internet search
Other; please explain

In the past month, how many visits did you make to our website?
1-2 visits
3-5 visits
6-10 visits
10+ visits
This is my first visit

Do you think that you will visit our website in the future?
Definitely
Maybe
Probably not; if not, please explain:

How can we improve our website to better meet your needs?

Comments or suggestions:

  

Thank you for your honest answers.  If you would like someone form The Supply Center to contact you, please include your information below:

Name (first, last):

Phone Number:

E-mail Address: