Graham Field JB0160-010B-220 Oxygen Equipment User Manual


 
QUESTIONNAIRE
1. Method of purchase: (check all that apply)
Medicare Insurance Medicaid Other
2. This product was purchased for use by: (check one)
Self Parent Spouse Other
3. This product was purchased for use at:
Home Facility Other
4. I purchased a Graham-Field product because:
Price Features (list features) Other
5. Who referred you to Graham-Field products? (check all that apply)
Doctor Therapist Friend
Relative Dealer/Provider Other
Advertisement (circle one): TV, Radio, Magazine, Newspaper
No Referral
6. What additional features, if any, would you like to see on this
product?
7. Would you like to receive information about Graham-Field products
that may be available for a particular medical condition?
Yes No
If yes, please list any condition(s) here and we will send you
information by email and/or regular mail about any available
Graham-Field products that may help treat, care for or manage such
condition(s):
8. Would you like to receive updated information via email or regular
mail about Graham-Field home medical products? Yes No
9. What would you like to see on the Graham-Field website?
10. Would you like to be part of future surveys for Graham-Field
products? Yes No
11. User’s year of birth:_______________
If at any time you wish not to receive future mailings from us, please
contact us at GF Health Products, Inc., 2935 Northeast Parkway,
Atlanta, GA 30360, 800-347-5678
To find more information about our products, visit www.grahamfield.com