"OxyLife's mission is to set a higher standard of quality in home respiratory service and customer satisfaction by providing professional and courteous care."

Your satisfaction is our mission! Please take a moment and fill in the form below so we will know if there is anything we can do to improve your experience with our company. Thank you for taking the time to give us feedback!

Oxylife Respiratory Services Customer Satisfaction Online Survey
Patient Name:        Phone #:      Start DOS:          Date Contacted:   Services Provided For Patient: O2      OCD      C/BI-PAP     Nebulizer      Wheelchair    Walker      Cane          Other: 1.  Did our representative call you in a timely manner to get your information & set you up?      Yes     No     I don't know 2.  Did our technician arrive in the time that was scheduled?      Yes     No     I don't know 3.  Was our representative polite & courteous with you?      Yes     No     I don't know 4.  Do you (or someone in your household) know how to operate your equipment?      Yes     No     I don't know 5.  Do you have our contact information in case you need to reach us?      Yes     No     I don't know 6.  Did we satisfy your expectations?      Yes     No     I don't know 7.  Would you refer us to a friend or neighbor?      Yes     No     I don't know 8.  How would you rate our services?      Wonderful!     Good     Not Good Completed By: